The relationship between serum Metrnl and GDF11 expression levels with lower extremity vascular disease and prog-nosis in patients with diabetic foot infection

Wang Chenge; Wang Xiaodong; Luo Yuming; Chai Qian; Yang Jiao

doi:10.3969/j.issn.1671-6450.2025.04.006

Abstract：Objective To investigate the relationship between serum Meteorin-like protein(Metrnl)and growth dif-ferentiation factor 11(GDF11)expression levels with lower extremity vascular disease(LEVD)and prognosis in patients with diabetic foot(DF)infection.Methods A total of 97 DF infection patients admitted to the Department of Endocrinology,Shangluo Central Hospital,from January 2022 to December 2023 were selected as the DF group,and 97 patients with type 2 diabetes mellitus(T2DM)alone were selected as the T2DM group.DF infection patients were further divided into the LEVD subgroup(n=73)and the non-LEVD subgroup(n=24)based on the presence of LEVD.After a 6-month follow-up(with 2 lost to follow-up),DF infection patients were categorized into the poor prognosis subgroup(n=30)and the good prognosis subgroup(n=65).Additionally,97 healthy individuals undergoing physical examinations during the same period were in-cluded as the healthy control group.Serum Metrnl and GDF11 levels were measured using enzyme-linked immunosorbent assay(ELISA).Multivariate logistic regression analysis was performed to identify factors influencing poor prognosis in DF infection patients.Receiver operating characteristic(ROC)curve analysis was used to evaluate the predictive value of serum Metrnl and GDF11 levels for poor prognosis in DF infection patients.Results Serum Metrnl and GDF11 levels followed the order:DF group＜T2DM group＜healthy control group(F/P=2 058.898/＜0.001,139.757/＜0.001).The LEVD subgroup exhibited lower serum Metrnl and GDF11 levels compared to the non-LEVD subgroup(t/P=4.165/＜0.001,6.469/＜0.001).After 6 months of follow-up(with 2 lost),the incidence of poor prognosis was 31.58％(30/95).The poor prognosis sub-group had longer T2DM and DF duration,higher proportions of LEVD,higher HbA1c levels,and lower serum Metrnl and GDF11 levels compared to the good prognosis subgroup(t/P=6.603/＜0.001,11.567/＜0.001,5.410/0.020,7.832/＜0.001,3.891/＜0.001,4.983/＜0.001).Multivariate logistic regression analysis showed that LEVD and high HbA1c levels were inde-pendent risk factors for poor prognosis[OR(95％CI)=2297(1.145-4.599),1.881(1.043-3.394)],while high serum Metrnl and GDF11 levels were independent protective factors[OR(95％CI)=0.656(0.488-0.882),0.680(0.519-0.892)].The area under the curve(AUC)for predicting poor prognosis using serum Metrnl,GDF11,and their combination was 0.774,0.737,and 0.902,respectively.The combined AUC was significantly higher than individual predictions(Z/P=2.239/0.002,2.836/＜0.001).Conclusion Serum Metrnl and GDF11 levels are decreased in DF infection patients and are associated with LEVD.Combined detection of serum Metrnl and GDF11 levels has high predictive value for poor prognosis in DF infection patients.