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OBJECTIVE: The goal of this study was to evaluate whether circulating endothelial precursor cells (CEPCs) and neutrophil microparticles (MP) can predict diabetic foot ulcer healing. RESEARCH DESIGN AND METHODS: A multicenter study was designed to evaluate circulating cellular markers, CEPCs and MPs, as prognostic factors associated with the healing of DFU by the 16(th) week of care. Flow cytometry analysis of CEPCS and MPs were obtained at the first visit and compared to wound healed status. RESULTS: 207 subjects were enrolled at four sites. 40.0% (28.4,41.5) of the subjects healed by the 16(th) week of care. Several CEPCs measured were associated with healing after adjustment for wound area and wound duration. Typical of this analysis was CD34(+)CD45(dim), the univariate OR was 1.19(0.88,1.61) and after adjustment for wound area and wound duration the OR was 1.67(1.16,2.42) p=0.006). A prognostic model with CEPCs CD34(+) CD45(dim), wound area, and wound duration had an area under the curve (AUC) of 0.75(0.67, 0.82) and, simpler, CD34(+) CD45(dim) per initial wound area, as a solitary predictor, has an AUC of 0.72 (0.64, 0.79). MPs were not associated with a healed wound. CONCLUSIONS: Previous studies have indicated that CEPCs measured at the first office visit are associated with a healed DFU. In this multi-centered prospective study, we confirm this finding, show the importance of adjusting CEPCs measurements by wound are, and show that a single number based on CEPCs per wound area is highly predictive of a healed DFU by 16(th) week of care. |
