The Relationship between Inflammatory Markers and Mean Platelet Volume in Patients with Diabetic Foot Infection

  • Cigdem Ozkan nevşehir devlet hastanesi
  • Işılay Kalan
  • Özlem Turhan İyidir
  • Ethem Turgay Cerit
  • Müjde Aktürk
  • Alev Altınova
  • Füsun Baloş Törüner
  • Metin Arslan
Keywords: Diabetic foot infection, inflammatory markers, mean platelet volume


Objective: Diabetic foot infections (DFI) is one of the most common and debilitating complications of diabetes. Mean platelet volume (MPV), which is reported routinely in complete blood count has been shown to be increased in patients with diabetes. Higher MPV values have also been shown to be related with increased risk of cardiovascular events and thrombosis. In this study we aimed to study MPV values in DFI during the acute stage and after treatment, and its relationship between inflammatory markers.Patients and Methods: Data of all diabetic patients with DFI followed up in the Endocrinology and Metabolism Unit of Gazi University Hospital between 2004-2012 were reviewed. Forty-seven patients with diabetic foot osteomyelitis were included into the study. Erythrocyte sedimentation rate (ESR), C-reactive protein (CRP), white blood cell (WBC) count, platelet count, and MPV levels were recorded at baseline and after treatment from the computerized patient registry database.Results: The mean age of the patients included in the study was 59.4 ± 10.0 years. Thirty-one (66%) patients were male. Median duration of diabetes was 15 (3-30) years. Median HbA1c was 7.9% (5.2-14). ESR, CRP, WBC and platelet counts were significantly decreased after treatment when compared to the baseline (p < 0.05). Following the treatment, we found an increase in MPV values from 8.58 ± 1.38 to 8.68 ± 1.74 (fl), but this was not statistically significant (p>0.05). MPV did not correlate with ESR, CRP and WBC counts before and after treatment in diabetic foot osteomyelitis.Conclusion: The results of our study suggest that values of MPV might not be used as a marker in DFI. Prospective studies with larger number of patients are needed to evaluate the role of MPV in diabetic foot infections.


Richard JL, Lavigne JP, Sotto A. Diabetes and foot infection: more than double trouble. Diabetes Metab Res Rev 2012;28 Suppl 1:46-53.

Lipsky BA, Peters EJ, Senneville E, et al. Expert opinion on the management of infections in the diabetic foot. Diabetes Metab Res Rev 2012;28 Suppl 1:163-78.

Nyazee HA, Finney KM, Sarikonda M, et al. Diabetic foot osteomyelitis: bone markers and treatment outcomes. Diabetes Res Clin Pract 2012;97:411-7.

Michail M, Jude E, Liaskos C, et al. The performance of serum inflammatory markers for the diagnosis and follow-up of patients with osteomyelitis. The international journal of lower extremity wounds 2013;12:94-9.

Fleischer AE, Didyk AA, Woods JB, Burns SE, Wrobel JS, Armstrong DG. Combined clinical and laboratory testing improves diagnostic accuracy for osteomyelitis in the diabetic foot. The Journal of foot and ankle surgery : official publication of the American College of Foot and Ankle Surgeons 2009;48:39-46.

Jeandrot A, Richard JL, Combescure C, et al. Serum procalcitonin and C-reactive protein concentrations to distinguish mildly infected from non-infected diabetic foot ulcers: a pilot study. Diabetologia 2008;51:347-52.

Park Y, Schoene N, Harris W. Mean platelet volume as an indicator of platelet activation: methodological issues. Platelets 2002;13:301-6.

Inui Y, Suehiro T, Kumon Y, Hashimoto K. Platelet volume and urinary prostanoid metabolites in non-insulin-dependent diabetes mellitus. J Atheroscler Thromb 1994;1:108-12.

Zuberi BF, Akhtar N, Afsar S. Comparison of mean platelet volume in patients with diabetes mellitus, impaired fasting glucose and non-diabetic subjects. Singapore Med J 2008;49:114-6.

Hekimsoy Z, Payzin B, Ornek T, Kandogan G. Mean platelet volume in Type 2 diabetic patients. J Diabetes Complications 2004;18:173-6.

Leader A, Pereg D, Lishner M. Are platelet volume indices of clinical use? A multidisciplinary review. Annals of medicine 2012;44:805-16.

Slavka, G., Perkmann, T., Haslacher, H., Greisenegger, S., Marsik, C.,

Wagner, Mean platelet volume may represent a predictive parameter

for overall vascular mortality and ischemic heart disease. Arteriosclerosis,

thrombosis, and vascular biology 2011; 31: 1215-8.

Kisacik B, Tufan A, Kalyoncu U, et al. Mean platelet volume (MPV) as an inflammatory marker in ankylosing spondylitis and rheumatoid arthritis. Joint, bone, spine : revue du rhumatisme 2008;75:291-4.

Kapsoritakis AN, Koukourakis MI, Sfiridaki A, et al. Mean platelet volume:

a useful marker of inflammatory bowel disease activity. Am J Gastroenterol


Lipsky BA, Berendt AR, Cornia PB, et al. 2012 Infectious Diseases Society of America clinical practice guideline for the diagnosis and treatment of diabetic foot infections. Clinical infectious diseases : an official publication of the Infectious Diseases Society of America 2012;54:e132-73.

Winkley K, Stahl D, Chalder T, Edmonds ME, Ismail K. Quality of life in

people with their first diabetic foot ulcer: a prospective cohort study. Journal

of the American Podiatric Medical Association 2009;99:406-14.

Uckay I, Aragon-Sanchez J, Lew D, Lipsky BA. Diabetic foot infections: what have we learned in the last 30 years? International journal of infectious diseases : IJID : official publication of the International Society for Infectious Diseases 2015;40:81-91.

Satman I, Yilmaz T, Sengul A, et al. Population-based study of diabetes and risk characteristics in Turkey: results of the turkish diabetes epidemiology study (TURDEP). Diabetes Care 2002;25:1551-6.

Satman I, Omer B, Tutuncu Y, et al. Twelve-year trends in the prevalence and risk factors of diabetes and prediabetes in Turkish adults. European journal of epidemiology 2013;28:169-80.

Saltoglu N, Yemisen M, Ergonul O, et al. Predictors for limb loss among patient with diabetic foot infections: an observational retrospective multicentric study in Turkey. Clinical microbiology and infection : the official publication of the European Society of Clinical Microbiology and Infectious Diseases 2015;21:659-64.

Van Asten SA, Nichols A, La Fontaine J, Bhavan K, Peters EJ, Lavery LA. The value of inflammatory markers to diagnose and monitor diabetic foot osteomyelitis. International wound journal 2015.

Yuksel O, Helvaci K, Basar O, et al. An overlooked indicator of disease activity in ulcerative colitis: mean platelet volume. Platelets 2009;20:277-81.

Endler G, Klimesch A, Sunder-Plassmann H, et al. Mean platelet volume is

an independent risk factor for myocardial infarction but not for coronary

artery disease. Br J Haematol 2002;117:399-404.

Sharpe PC, Trinick T. Mean platelet volume in diabetes mellitus. The Quarterly journal of medicine 1993;86:739-42.

Papanas N, Symeonidis G, Maltezos E, et al. Mean platelet volume in patients with type 2 diabetes mellitus. Platelets 2004;15:475-8.

Domingueti CP, Dusse LM, Carvalho MD, de Sousa LP, Gomes KB, Fernandes AP. Diabetes mellitus: The linkage between oxidative stress, inflammation, hypercoagulability and vascular complications. J Diabetes Complications 2015.

Demirtunc R, Duman D, Basar M, Bilgi M, Teomete M, Garip T. The relationship between glycemic control and platelet activity in type 2 diabetes mellitus. J Diabetes Complications 2009;23:89-94.

Tschoepe D, Roesen P, Esser J, et al. Large platelets circulate in an activated state in diabetes mellitus. Seminars in thrombosis and hemostasis 1991;17:433-8.

Iwase E, Tawata M, Aida K, et al. A cross-sectional evaluation of spontaneous platelet aggregation in relation to complications in patients with type II diabetes mellitus. Metabolism 1998;47:699-705.

Karadurmus N, Sahin M, Tasci C, et al. Potential benefits of hyperbaric oxygen therapy on atherosclerosis and glycaemic control in patients with diabetic foot. Endokrynologia Polska 2010;61:275-9.

Original Research