Serum Albumin as a Marker of Infection Severity and Clinical Course in Patients with Diabetic Foot Infection

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Objective: This study aimed to evaluate the association between admission serum albumin levels, infection severity, and clinical outcomes in patients hospitalized and managed surgically for diabetic foot disease. Materials and Methods: This retrospective, single-center observational cohort study included adult patients hospitalized for diabetic foot wounds who underwent surgical treatment (debridement or amputation) and received enteral nutritional support at a tertiary training hospital between January and April 2025. Clinical data, including length of hospital stay, duration of enteral nutrition, and duration of intravenous antibiotic therapy, together with laboratory parameters such as admission and discharge serum albumin levels, were obtained from medical records. Infection severity was assessed using the infection component of the PEDIS classification system. Patients were categorized into the low-to-moderate severity (PEDIS Infection Grades 1–2) and advanced severity (PEDIS Infection Grade 3) groups for comparative analyses. Results: A total of 69 patients were included in the study. The mean age of the study population was 66.6 ± 10.6 years, and 75.4% of the patients were male. Median serum albumin levels increased significantly during hospitalization, from 3.1 g/dL (2.1–4.5) at admission to 3.3 g/dL (1.6–4.3) at discharge (p = 0.001). Patients with PEDIS Infection Grade 3 disease had significantly lower admission serum albumin levels than those with PEDIS Infection Grades 1–2 (2.8 g/dL [2.1–3.7] vs. 3.2 g/dL [2.5–4.5], p = 0.001). In addition, patients with advanced disease had significantly longer hospital stays (16 days [3–86] vs. 8 days [3–33], p = 0.004), longer durations of enteral nutritional support (14 vs. 7 days, p = 0.001), and prolonged intravenous antibiotic therapy (15 vs. 7 days, p = 0.004). No significant differences were observed between groups regarding HbA1c, hemoglobin, platelet count, or C-reactive protein levels (all p > 0.05). Conclusion: Low admission serum albumin levels were associated with advanced infection severity in patients with diabetic foot infection. Advanced disease severity was accompanied by longer hospitalization, prolonged antibiotic therapy, and increased nutritional support requirements. Serum albumin may serve as a practical and readily available biomarker for assessing disease severity and monitoring the clinical course in patients with diabetic foot disease.

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