Wukich et al describe severe diabetic foot infections in terms of the features of the systemic inflammatory response syndrome (SIRS). The authors are from the University of Pittsburgh.
Patient selection: diabetic foot infection
Parameters:
(1) body temperature in °C
(2) heart rate in beats per minute
(3) respiratory rate in breaths per minute
(4) white blood cell count per µL
(5) systolic blood pressure in mm Hg
(6) serum glucose in mg/dL
(7) BUN to creatinine ratio (as measure of prerenal azotemia)
(8) metabolic acidosis based on bicarbonate and anion gap (anion gap > 15 mmol/L and serum bicarbonate < 22 mmol/L)
Parameter
Finding
Points
body temperature
> 38°C
1
36 to 38°C
0
< 36°C
1
heart rate
<= 90 beats per minute
0
> 90 beats per minute
1
respiratory rate
<= 20 breaths per minute
0
> 20 breaths per minute
1
WBC count
< 4,000 per µL
1
4,000 to 12,000
0
> 12,000 per µL
1
systolic blood pressure
>= 90 mm Hg
0
< 90 mm Hg
1
serum glucose
<= 200 mg/dL
0
> 200 mg/dL
1
BUN to creatinine ratio
<= 20
0
> 20
1
metabolic acidosis
absent
0
present
1
total score =
= SUM(points for all 8 parameters)
Interpretation:
• minimum score: 0
• maximum score: 8
• A score >= 2 indicates severe infection.
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