Systemic inflammatory response syndrome as a predictor of poorer outcomes in diabetic foot infection: a prospective analytical study

Anand Vinay Karnawat, Vijayakumar Chellappa, Balasubramanian Gopal, Rajkumar Nagarajan, Krishnamachari Srinivasan


Background: This study was done to diagnose the severity of infection in a group of hospitalized diabetic foot infection (DFI) patients based on the presence or absence of systemic inflammatory response syndrome (SIRS) and compare the outcomes.

Methods: This was a single-center cohort study, in which 50 consecutive DFI patients having SIRS and 50 consecutive patients not having SIRS were included. Patients were followed for the duration of the hospital stay; parameters for glycaemic control, minor and major amputation, microbial culture, duration of hospital and ICU stay and mortality was recorded.

Results: The relative risk of major amputation among the patients of DFI who presented with SIRS was 2.66 times higher compared to who was not having SIRS at presentation (95% CI, 1.56-4.55). The presence of polymicrobial infection also had a statistically significant association with the incidence of major amputation. The duration of hospital stay was ~9.5 days longer in the DFI patients who presented with SIRS compared to who was not having SIRS at the time of presentation [8.00 (4.00-20.50) days versus 17.50 (10.75-38.25) days]. DFI patients with SIRS required a significantly prolonged ICU.

Conclusions: SIRS can be used as objective criteria to predict poorer outcomes in the diabetic foot infection patient and also to classify it. 


DFI, Morbitity, Sepsis, SIRS, Quality of life

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