Associations of cortisol secretion status with severity and prognosis of diabetic foot ulcers

Objective Cortisol secretion status were analyzed under different conditions of diabetic foot ulcers (DFU) to investigate their relationship and impact on the prognosis of DFU. Methods Materials from 188 patients with DFU and 173 patients with high risk factors to DFU admitted to Ruijin Hospital during March, 2010 to March, 2012 were collected and all the patients were classified into several groups according to Wagner grade (Wagner 0 to 5) and infection degree (non-, mild, moderate and severe infection) respectively. The relationship of adrenocorticotropin(ACTH), the plasma cortisol of 08∶00, 16∶00, 24∶00 time point and urinary free cortisol (UFC) in 24 hours with severity of DFU and infection were analyzed; All patients were followed up for 3 months to observe the impact of cortisol levels on healing rates of DFU. Linear regression analysis was used to assess the variation trends of all continuous variables. Results With Wagner grade stepping up, the plasma cortisol of 08∶00, 16∶00, 24∶00 time point and urinary free cortisol (UFC) in 24 hours were increasing gradually (F=8.47, 19.15, 14.58, 6.23, all P for trend 0.05). There is a strong association between elevated plasma cortisol levels and low healing rates of DFU, for patients with normal, increasing or remarkably increasing levels of 08∶00 plasma cortisol and urinary free cortisol (UFC) in 24 hours at baseline had significantly different ulcer healing rates (χ2=3.09, 9.56, P<0.05). Conclusions Cortisol levels increased when DFU getting worse with ulcer depth and infection, meanwhile ulcer healing rates reduced. These suggested that cortisol level could be used as an indicator to evaluate the severity of DFU. Key words: Diabetic foot; Ulcer; Infection; Cortisol