Serum Procalcitonin in Diabetes Mellitus with and Without Pulmonary Tuberculosis
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Abstract
Diabetes mellitus (DM) is associated with immune dysfunction and increased susceptibility to pulmonary tuberculosis (TB). Procalcitonin (PCT) is widely used as a biomarker of bacterial infection, but its concentrations in patients with DM and pulmonary TB remain insufficiently characterized. To compare serum PCT concentrations between patients with DM with and without active pulmonary TB. This analytical cross-sectional study included 50 patients with DM recruited from two primary healthcare centers in Jambi, Indonesia, from March to June 2025. Participants comprised 34 patients without pulmonary TB and 16 with active pulmonary TB. Serum PCT was measured using fluorescence immunoassay. Non-normally distributed PCT concentrations were summarized using the median and interquartile range (IQR) and compared using the Mann–Whitney U test.PCT concentrations were within the normal reference range (<0.05 ng/mL) in 33/34 (97.1%) patients without pulmonary TB and 13/16 (81.3%) patients with active pulmonary TB. Because measurements at or below 0.05 ng/mL were retained as thresholded values, the median (IQR) was ≤0.05 (≤0.05–≤0.05) ng/mL in both groups. No statistically significant between-group difference was identified (U = 230.000, Z = −1.857, p = 0.063). Serum PCT concentrations did not differ significantly between patients with DM with and without active pulmonary TB. Larger studies with standardized TB confirmation, assessment of treatment status and relevant confounders, and diagnostic-accuracy analyses are warranted.
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References
Ahmed El-Banna, K., Abd El-Fattah El-Messallamy, F., Saeed Abdo Soliman, J., Saad Ghanim, N., Atef Zaki El-naggar, A., Sallam Soliman, A., & Usama Khalil, N. (2024). Procalcitonin/Lactate Ratio as a Diagnostic Marker for Osteomyelitis in Patients with Diabetic Foot Ulcers. In The Egyptian Journal of Hospital Medicine (Vol. 96).
Al-Bari, M. A. A., Peake, N., & Eid, N. (2024). Tuberculosis-diabetes comorbidities: Mechanistic insights for clinical considerations and treatment challenges. World Journal of Diabetes, 15(5), 853–866. https://doi.org/10.4239/wjd.v15.i5.853
Alexander, M., Cho, E., Gliozheni, E., Salem, Y., Cheung, J., & Ichii, H. (2024). Pathology of Diabetes-Induced Immune Dysfunction. In International Journal of Molecular Sciences (Vol. 25, Number 13). Multidisciplinary Digital Publishing Institute (MDPI). https://doi.org/10.3390/ijms25137105
Ali, H., Mohamed, A., Mohamed, L., Eltoukhy, A., Mohamed, S., Attia, M., Hamed, W., Behery, H., Mohammed, A., & Suliman, H. (2025). The Value of Using Procalcitonin Instead of CRP as A Biomarker of Sepsis in Hospitalized Patients in Al-Ahrar Teaching Hospital General Organization of Teaching Hospitals and Institutes, Egypt. In The Egyptian Journal of Hospital Medicine (Vol. 100).
Al-Laith, Z. N. (2025). Procalcitonin as a Biomarker for Bacterial Infections: Clinical Applications: Kalsitonin sebagai Biomarker untuk Infeksi Bakteri: Aplikasi Klinis. Indonesian Journal on Health Science and Medicine, 2(1), https://doi.org/10.21070/ijhsm.v2i1.190.
American Diabetes Association Professional Practice Committee. (2023a). 1. Improving Care and Promoting Health in Populations: Standards of Care in Diabetes—2024. Diabetes Care, 47(Supplement_1), S11–S19. https://doi.org/10.2337/dc24-S001
American Diabetes Association Professional Practice Committee. (2023b). 2. Diagnosis and Classification of Diabetes: Standards of Care in Diabetes—2024. Diabetes Care, 47(Supplement_1), S20–S42. https://doi.org/10.2337/dc24-S002
Ardian, L. J. (2024). The Role of Procalcitonin to Determine Infection in Diabetic Foot Ulcer: An Evidence-Based Case Report. Journal of Diverse Medical Research: Medicosphere, 1(4), 7–22.
Awad, S. F., Critchley, J. A., & Abu-Raddad, L. J. (2022). Impact of diabetes mellitus on tuberculosis epidemiology in Indonesia: A mathematical modeling analysis. Tuberculosis, 134, 102164. https://doi.org/10.1016/j.tube.2022.102164
Biswas, S., Rani, F., Haque, S., Suman, D., & Dixit, R. (2025). Procalcitonin: A Revolutionary Biomarker in the Diagnosis and Management of Infections. International Journal of Life Sciences, Biotechnology and Pharma Research, 14, 498–503. https://doi.org/10.69605/ijlbpr_14.2.2025.93
Buasroung, P., Petnak, T., Liwtanakitpipat, P., & Kiertiburanakul, S. (2022). Prevalence of Diabetes Mellitus in Patients with Tuberculosis: A Prospective Cohort Study. International Journal of Infectious Diseases, 116, 374–379. https://doi.org/10.1016/j.ijid.2022.01.047
Chaubey, G. K., Modanwal, R., Dilawari, R., Talukdar, S., Dhiman, A., Chaudhary, S., Patidar, A., Raje, C. I., & Raje, M. (2024). Chronic hyperglycemia impairs anti-microbial function of macrophages in response to Mycobacterium tuberculosis infection. Immunologic Research, 72(4), 644–653. https://doi.org/10.1007/s12026-024-09462-z
Cho, S. H., Jeong, S. H., Shin, J., Park, S., & Jang, S.-I. (2022). Short-term smoking increases the risk of insulin resistance. Scientific Reports, 12(1), 3550. https://doi.org/10.1038/s41598-022-07626-1
Franco, J. V., Bongaerts, B., Metzendorf, M.-I., Risso, A., Guo, Y., Silva, L. P., Boeckmann, M., Schlesinger, S., Damen, J. A., Richter, B., Baddeley, A., Bastard, M., Carlqvist, A., Garcia-Casal, M. N., Hemmingsen, B., Mavhunga, F., Manne-Goehler, J., & Viney, K. (2024). Diabetes as a risk factor for tuberculosis disease. Cochrane Database Syst Rev, 8(8). https://doi.org/10.1002/14651858.CD016013
Holt, R. I. G., Cockram, C. S., Ma, R. C. W., & Luk, A. O. Y. (2024). Diabetes and infection: review of the epidemiology, mechanisms and principles of treatment. Diabetologia, 67(7), 1168–1180. https://doi.org/10.1007/s00125-024-06102-x
Holt, R. I., Cockram, C. S., Ma, R. C., & Luk, A. O. (2024). Diabetes and infection: review of the epidemiology, mechanisms and principles of treatment. Diabetologia, 67(7), 1168-1180. https://doi.org/10.1007/s00125-024-06102-x
Jiang, K., Luan, H., Pu, X., Wang, M., Yin, J., & Gong, R. (2022). Association Between Visceral Adiposity Index and Insulin Resistance: A Cross-Sectional Study Based on US Adults. Frontiers in Endocrinology, Volume 13-2022.
Kapur, A., & Harries, A. D. (2013). The double burden of diabetes and tuberculosis–public health implications. Diabetes research and clinical practice, 101(1), 10-19. https://doi.org/10.1016/j.diabres.2012.12.001
Khalil, I., & Hossain, M. I. (2025). Tuberculosis and diabetes mellitus: a narrative review on the growing syndemic in low-and middle-income countries. Discover Public Health, 22(1), 400. https://doi.org/10.1186/s12982-025-00785-2
Khanam, A., Hithamani, G., Naveen, J., Pradeep, S. R., Barman, S., & Srinivasan, K. (2023). Management of invasive infections in diabetes mellitus: A comprehensive review. Biologics, 3(1), 40-71. https://doi.org/10.3390/biologics3010004
Kim, T., & Choi, S. H. (2025). Diabetes mellitus and infectious diseases: current evidence and clinical implications. Diabetes & metabolism journal, 49(5), 915-933. https://doi.org/10.4093/dmj.2025.0508
Kong, X., Pan, S., Huang, B., & Zhao, L. (2026). The Predictive Value of Dynamic Changes in Procalcitonin and C-Reactive Protein in Evaluating Response of Patients with Pulmonary Tuberculosis in the Early Treatment. Infection and Drug Resistance, 19, 1–14. https://doi.org/10.2147/IDR.S566150
Lee, H., Kim, M.-J., Lee, I.-K., Hong, C.-W., & Jeon, J.-H. (2024). Impact of hyperglycemia on immune cell function: a comprehensive review. Diabetology International, 15(4), 745–760. https://doi.org/10.1007/s13340-024-00741-6
Leo, S., Narasimhan, M., Rathinam, S., & Banerjee, A. (2024). Biomarkers in diagnosing and therapeutic monitoring of tuberculosis: a review. Annals of Medicine, 56(1), 2386030. https://doi.org/10.1080/07853890.2024.2386030
Lodi, G., Sergi, D., Dipinto, A., Bompan, F., Secchiero, P., Voltan, R., & Romani, A. (2026). Hyperglycemia-Induced Endothelial Dysfunction: From Classical Pathogenetic Mechanisms to Emerging Insights into ACE2 Protective Action. In International Journal of Molecular Sciences (Vol. 27, Number 6). Multidisciplinary Digital Publishing Institute (MDPI). https://doi.org/10.3390/ijms27062660
Magliano, D. J., Boyko, E. J., & Atlas, I. D. F. D. (2021). Global picture. In IDF DIABETES ATLAS [Internet]. 10th edition. International Diabetes Federation.
Marzoa Jansana, M. D., Tárraga López, P. J., Guarro Miquel, J. J., López-González, Á. A., Riutord Sbert, P., Busquets-Cortés, C., & Ramírez-Manent, J. I. (2025). Sociodemographic Factors, Healthy Habits, and Quality of Life in Relation to Insulin Resistance Risk in a Large Cohort of Spanish Workers. Medical Sciences, 13(3). https://doi.org/10.3390/medsci13030122
Mboi, N., Syailendrawati, R., Ostroff, S. M., Elyazar, I. R., Glenn, S. D., Rachmawati, T., ... & Mokdad, A. H. (2022). The state of health in Indonesia's provinces, 1990–2019: a systematic analysis for the Global Burden of Disease Study 2019. The Lancet Global Health, 10(11), e1632-e1645.
Omar, J., Ahmad, N. S., Che-Soh, N. A. A., Wan-Azman, W. N., Yaacob, N. M., Abdul-Ghani, N. S., & Abdullah, M. R. (2023). Serum Procalcitonin (PCT)-Is there a Role as an Early Biomarker in Infected Diabetic Foot Ulcer (IDFU) Patients? Malaysian Orthopaedic Journal, 17(2), 62–69. https://doi.org/10.5704/MOJ.2307.010
Pacinella, G., Ciaccio, A. M., & Tuttolomondo, A. (2022). Endothelial Dysfunction and Chronic Inflammation: The Cornerstones of Vascular Alterations in Age-Related Diseases. In International Journal of Molecular Sciences (Vol. 23, Number 24). MDPI. https://doi.org/10.3390/ijms232415722
Peng, Y.-F. (2023). Pulmonary tuberculosis and diabetes mellitus: Epidemiology, pathogenesis and therapeutic management (Review). Medicine International, 4(1). https://doi.org/10.3892/mi.2023.128
Selvan, P., Nagesh, N. J., Vajravelu, L. K., Akram, C. S., & Karniha, B. (2024). A Bidirectional Immunological Relationship between Diabetes Mellitus and Tuberculosis: A Narrative Review. JOURNAL OF CLINICAL AND DIAGNOSTIC RESEARCH. https://doi.org/10.7860/jcdr/2024/67692.18994
Sossen, B., Richards, A. S., Heinsohn, T., Frascella, B., Balzarini, F., Oradini-Alacreu, A., Odone, A., Rogozinska, E., Häcker, B., Cobelens, F., Kranzer, K., Houben, R. M. G. J., & Esmail, H. (2023). The natural history of untreated pulmonary tuberculosis in adults: a systematic review and meta-analysis. The Lancet Respiratory Medicine, 11(4), 367–379. https://doi.org/10.1016/S2213-2600(23)00097-8
Susanti, E. W., Wiratama, B. S., & Hsieh, F. I. (2026). Age differences in factors associated with pulmonary tuberculosis: a cross-sectional study of Indonesian Basic Health Research (RISKESDAS) 2018. Infectious Diseases, 58(2), 221-232. https://doi.org/10.1080/23744235.2025.2562230
Thimmappa, P. Y., Vasishta, S., Ganesh, K., Nair, A. S., & Joshi, M. B. (2023). Neutrophil (dys)function due to altered immuno-metabolic axis in type 2 diabetes: implications in combating infections. Human Cell, 36(4), 1265–1282. https://doi.org/10.1007/s13577-023-00905-7
Todorova, Ani S, Dimova, Rumyana B, Chakarova, Nevena Y, Serdarova, Mina S, Grozeva, Greta G, Georgiev, Georgi K, & Tankova, Tsvetalina I. (2023). Comparative Evaluation of the Diagnostic Value of Procalcitonin and hsCRP for the Presence of Mild-to-Moderate Diabetic Foot Infections. The International Journal of Lower Extremity Wounds, 22(2), 353–359. https://doi.org/10.1177/15347346211011849
van der Velde, J. H. P. M., Boone, S. C., Winters-van Eekelen, E., Hesselink, M. K. C., Schrauwen-Hinderling, V. B., Schrauwen, P., Lamb, H. J., Rosendaal, F. R., & de Mutsert, R. (2023). Timing of physical activity in relation to liver fat content and insulin resistance. Diabetologia, 66(3), 461–471. https://doi.org/10.1007/s00125-022-05813-3
Vega, V., Cabrera-Sanchez, J., Rodríguez, S., Verdonck, K., Seas, C., Otero, L., & Van der Stuyft, P. (2024). Risk factors for pulmonary tuberculosis recurrence, relapse and reinfection: a systematic review and meta-analysis. BMJ Open Respiratory Research, 11(1), e002281. https://doi.org/10.1136/bmjresp-2023-002281
Weeratunga, P., Moller, D. R., & Ho, L. P. (2024). Immune mechanisms of granuloma formation in sarcoidosis and tuberculosis. The Journal of clinical investigation, 134(1). https://doi.org/10.1172/JCI175264
Xu, H. G., Tian, M., & Pan, S. Y. (2022). Clinical utility of procalcitonin and its association with pathogenic microorganisms. Critical Reviews in Clinical Laboratory Sciences, 59(2), 93-111. https://doi.org/10.1080/10408363.2021.1988047
Yameny, A. A. (2024). Diabetes mellitus overview 2024. Journal of Bioscience and Applied Research, 10(3), 641-645. https://doi.org/10.21608/jbaar.2024.382794
Ye, Z., Li, L., Yang, L., Zhuang, L., Aspatwar, A., Wang, L., & Gong, W. (2024, October). Impact of diabetes mellitus on tuberculosis prevention, diagnosis, and treatment from an immunologic perspective. In Exploration (Vol. 4, No. 5, p. 20230138). https://doi.org/10.1002/EXP.20230138
Zhao, L., Fan, K., Sun, X., Li, W., Qin, F., Shi, L., ... & Zheng, C. (2024). Host-directed therapy against mycobacterium tuberculosis infections with diabetes mellitus. Frontiers in Immunology, 14, 1305325. https://doi.org/10.3389/fimmu.2023.1305325