Assessment of Hematological Relations in Patients With Diabetic Foot Syndrome

Abstract

Background. Type 2 diabetes mellitus (DM 2) is one of the significant medical, social and economic problems in the Republic of Belarus due to the high prevalence and development of severe complications. The need to predict and prevent diabetic foot ulcer (DFU) is becoming one of the most urgent clinical tasks, which requires the introduction into practice of indicators available for routine determination that can predict the course of DFU. Objective. To study the prognostic significance of the hematological ratio in assessing the risk of occurrence and clinical course of DFU. Material and methods. A non-randomized study was performed, in which 74 patients participated. The entire sample was retrospectively divided into 2 groups: patients with DM 2 (control group, n=43) and patients with DM 2 who have DFU (experimental group, n=31). Venous blood was taken on an empty stomach to determine the level of neutrophils, lymphocytes, platelets, glycated hemoglobin (HbA1), neutrophil-lymphocytic ratio (NLR) and plateletlymphocytic ratio (PLR) were calculated. Results. It was revealed that the patients of the control and experimental groups did not differ in gender, age, body mass index (BMI), absolute number of lymphocytes and HbA1 level. It was found that in patients of the control group, the level of neutrophils, platelets, as well as NLR and PLR in the blood was statistically higher (p<0.05). Spearman's correlation analysis showed that in the control and experimental groups, all the studied indicators do not correlate with the NLR. In the experimental group, the BMI indicator negatively correlates with PLR (r=0.52; p<0.05), and Hba1c positively correlates with aphids (r=0.555; p<0.05). The NLR was equal in patients of category 1-3 according to the classification of DFU of the University of Texas (N=15) – 2.06 (1.55; 2.21) nmol/l, in patients of category 4-6 (N=16) – 4.33 (3.28; 5.73) (p<0.05). The PLR in patients with the smallest category was 95.88 (86.04; 108.63) nmol/l, in patients with the largest category – 174.98 (150.23; 210.64) (p<0.05). The area under the ROC curve for the indicators of NLR and PLR was the largest – 0.761 and 0.708, respectively. Conclusions. 1. The content of neutrophils and platelets in the blood, NLR and PLR was significantly higher in patients with DFU compared with patients who have DM 2 without DFU. 2. In patients with DM2 complicated by DFU, the indicator PLR negatively correlates with BMI and positively correlates with HbA1. 3. The NLR and PLR in patients with DFU increase with an increase in the risk of possible amputation of the lower limb during the year. 4. In patients with DFU the NLR and PLR have the great diagnostic value as a laboratory criterion of DFU.