SERUM TUMOR NECROSIS FACTOR-Α (TNF-Α): A POTENTIAL BIOMARKER FOR GRADING AND PROGRESSION OF DIABETIC FOOT ULCERS

Abstract

Background: Diabetic Foot Ulcers (DFUs) are a serious complication of diabetes, where inflammation significantly influences disease progression. Tumor Necrosis Factor-α (TNF-α), a key pro-inflammatory cytokine, impairs wound healing via NF-κB activation, apoptosis, and endothelial and fibroblast dysfunction. Aim: To investigate the role of serum TNF-α level in individuals with different grades of Diabetic Foot Ulcers. Methodology: A case-control study was conducted on 250 participants (125 DFU patients and 125 controls) at a tertiary care center. Serum TNF-α was measured using ELISA. Data were analyzed using the Shapiro-Wilk test and appropriate non-parametric tests. 
Results: The mean age of participants was 57.23 ± 10.72 years, with no significant difference in age and sex distribution between groups. DFU patients showed a significant association (p < 0.001) with longer duration of diabetes, smoking, family history of diabetes, and other comorbidities. Serum TNF-α levels increased progressively with advancing grades of DFUs. Kruskal-Wallis test with post hoc analysis demonstrated statistically significant differences in TNF-α level across all DFU grades and controls. Elevated TNF-α level were particularly pronounced in higher grades, indicating its association with disease severity. TNF-α also showed a rise peaking at grade 4 and 5 highlighting the link between increased local and systemic inflammation and extreme tissue necrosis. 
Conclusion: Serum TNF-α levels correlate strongly with DFU severity and may serve as a useful biomarker for disease progression and a potential therapeutic target in DFU management.