Monitoring the Prognosis of Diabetic Foot Ulcers: Predictive Value of Neutrophil-to-Lymphocyte Ratio and Red Blood Cell Distribution Width

Arıcan, Gökhun; Kahraman, Hamit Çağlayan; Özmeriç, Ahmet; İltar, Serkan; Alemdaroğlu, Kadir Bahadır

doi:10.1177/1534734620904819

Cited by 15 publications

(15 citation statements)

References 34 publications

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“…Only few studies have focused so far on the RDW in patients with DFUs. A previous study with a small sample size in Turkey reported that RDW was a predictive parameter for major amputation in patients with DFUs [ 26 ]. A recent conference abstract with little available detail indicated that RDW was a risk factor for all-cause mortality in a moderate-sized cohort of patients undergoing amputations due to DFUs [ 19 ].…”

Section: Discussionmentioning

confidence: 99%

Impact of red cell distribution width and red cell distribution width/albumin ratio on all-cause mortality in patients with type 2 diabetes and foot ulcers: a retrospective cohort study

Hong

Liu

et al. 2022

Cardiovasc Diabetol

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Background Red blood cell distribution width (RDW) has emerged as a prognostic factor for mortality in various diseases. Up to now, few studies have focused on the prognostic value of RDW in patients with diabetic foot ulcers (DFUs). This retrospective cohort study aimed to investigate the impact of RDW and RDW/albumin (ALB) ratio on all-cause mortality in patients with DFUs. Methods This study included 860 patients with DFUs in a tertiary academic hospital. The associations of RDW and RDW/ALB with all-cause mortality were assessed by multivariable cox regression analyses. The pairwise comparisons of receiver operating characteristic (ROC) curves were performed to compare the predictive performance of RDW and RDW/ALB ratio. Harrell’s concordance index, integrated discrimination improvement, and net reclassification improvement were used to estimate the improvements in risk discrimination. Results Patients with high RDW and RDW/ALB had lower overall survival rates (all P < 0.001). The multivariable Cox regression revealed that high RDW [adjusted hazard ratio (HR) 2.426, 95% confidence interval (CI): 1.557–3.778, P < 0.001] and high RDW/ALB (adjusted HR 2.360, 95% CI: 1.414–3.942, P = 0.001) were independent associated with high all-cause mortality. In subgroup analyses, the comparative analysis of ROC curves revealed that the discriminating ability of the RDW/ALB ratio was significantly superior to RDW in patients with no severe DFUs or no severe peripheral artery disease, or in young and middle-aged patients (all P < 0.05). Adding RDW and RDW/ALB ratio to base models improved discrimination and risk reclassification for all-cause mortality. Conclusions RDW and RDW/ALB ratio are robust and independent prognostic markers in patients with DFUs. The RDW/ALB ratio appears to be of more predictive value for mortality in younger and less severely ill patients with DFUs. Both RDW and RDW/ALB ratio can provide incremental predictive value for all-cause mortality over traditional risk factors. RDW and RDW/ALB ratio can be used to identify high-risk patients with DFUs.

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Section: Discussionmentioning

confidence: 99%

Impact of red cell distribution width and red cell distribution width/albumin ratio on all-cause mortality in patients with type 2 diabetes and foot ulcers: a retrospective cohort study

Hong

Liu

et al. 2022

Cardiovasc Diabetol

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“…Neutrophils have been proven to play a critical role in DFU (14-17). Arican et al showed that the neutrophil-tolymphocyte ratio can be a predict the prognosis of DFU, and a high neutrophil-to-lymphocyte ratio inhibits the healing process (15). Yang et al also found that citH3, a neutrophil extracellular trap (NET) specific marker, acts as an inhibitor in wound healing (17).…”

Section: Discussionmentioning

confidence: 99%

IL-1B can serve as a healing process and is a critical regulator of diabetic foot ulcer

Gan¹,

Yang²,

Fang³

et al. 2022

Ann Transl Med

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Background: Diabetic foot ulcer (DFU) is the main cause of disability in diabetic patients. However, the molecular changes underlying the occurrence and progression of DFU remain unclear. We conducted this study to examine gene alterations in different DFU patients.Methods: GSE143735 and GSE134431 transcriptome data sets were acquired from the Gene Expression Omnibus database, and differential expression analyses of the genes in these data sets were performed.A functional enrichment analysis of the differentially expressed genes (DEGs) was performed using clusterProfiler package in R. To examine the correlations between DEGs and significant immune-related genes, we identified the intersecting ulcer-related DEGs, healing-related DEGs, and immune-related DEGs.Finally, we further investigate the relationship between the selected genes with immune cell regulation via a single-sample gene set enrichment analysis, and the infiltration of 28 immune cells in common diabetes samples, unhealed DFU samples, and healed samples DFU were compared.Results: We found 238 upregulated genes and 207 downregulated genes in the diabetic foot (DF) patients with ulcers compared to the DF patients without ulcers, and 74 upregulated genes and 28 downregulated genes in the healed samples compared to the unhealed samples. To examine the main biological functions, we conducted a functional enrichment analysis. The results showed that the biological functions of functional enrichment analysis included neutrophil degranulation, leukocyte chemotaxis, myeloid leukocyte migration, phagosome, cytokine-cytokine receptor interaction, and the chemokine signaling pathway. Interleukin (IL)-1B was more highly expressed in patients with ulcers and healed DFU patients than those without ulcers and unhealed DFU patients. Finally, the immune cell abundance difference results showed that activated cluster of differentiation (CD) 8 T cells, central memory CD8 T cells, T follicular helper cells, myeloid-derived suppressor cells, natural killer T cells and monocytes were more highly infiltrated in normal diabetes patients and healed DFU patients than unhealed DFU patients. However, no difference was found between DF patients with and without ulcers.Conclusions: IL-1B is an inflammation gene that can be used to assess and regulate DFU progression.

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“…Therefore, a total of 22 studies involving 8832 patients were considered for review. 28-49 Between-study differences in design, methods, clinical characteristics, parameters evaluated, and data reporting did not allow a meta-analysis.…”

Section: Resultsmentioning

confidence: 99%

“…Two further studies investigated the role of NLR in predicting the risk of amputation in patients with DM foot ulcers. 30,31 The first was a retrospective study including 101 patients in which NLR values on admission and at day 14 of treatment were matched with laboratory and clinical data. 30 Baseline NLR was higher in severe cases classified in accordance with both Wagner and PEDIS infection scores (Wagner score: NLR 6.7 vs 4.2; P = .04; PEDIS score: NLR 6.3 vs 3.6; P = .03).…”

Section: Discussionmentioning

confidence: 99%

“…ROC analysis was also performed to evaluate cutoffs and predictive abilities. 31 The patients were divided in 4 groups, as for the study of Vatankhah et al 28 : major amputation, minor amputation, chronic wound, and complete healing. NLR values were significantly different between patients with major and minor amputations (8.7 ± 2.2 vs 3.5 ± 1.3, P = .002, respectively), as well as between patients with chronic wound and complete healing (4.1 ± 2.6 vs 2.4 ± 2.1, P = .01, respectively).…”

Section: Discussionmentioning

confidence: 99%

See 1 more Smart Citation

Blood Cell Count Biomarkers, Risk, and Outcomes of Ischemia-Related Lower Limb Amputations: A Systematic Review

Dettori¹,

Mangoni

Zinellu

et al. 2020

The International Journal of Lower Extremity Wounds

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Lower limb amputations due to ischemia represent an important health care and social issue. However, there are currently no specific biomarkers able to predict the risk of amputation and postamputation complications and prognosis. We conducted a systematic review of studies investigating whether blood cell count indexes of systemic inflammation are linked to the risk and the outcome of lower limb amputations due to ischemia. Overall, in 22 studies involving 8832 patients selected for review, several blood cell count indexes, particularly the neutrophil lymphocyte ratio, showed some promise in terms of predicting amputations and general outcomes of conservative and surgical treatments, as well as postamputation complications and prognosis. However, largely due to methodological limitations, further prospective studies are required to establish the clinical utility and applicability of blood cell indexes in the routine management of patients with ischemia-related lower limb amputations.

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Monitoring the Prognosis of Diabetic Foot Ulcers: Predictive Value of Neutrophil-to-Lymphocyte Ratio and Red Blood Cell Distribution Width

Cited by 15 publications

References 34 publications

Impact of red cell distribution width and red cell distribution width/albumin ratio on all-cause mortality in patients with type 2 diabetes and foot ulcers: a retrospective cohort study

Impact of red cell distribution width and red cell distribution width/albumin ratio on all-cause mortality in patients with type 2 diabetes and foot ulcers: a retrospective cohort study

IL-1B can serve as a healing process and is a critical regulator of diabetic foot ulcer

Blood Cell Count Biomarkers, Risk, and Outcomes of Ischemia-Related Lower Limb Amputations: A Systematic Review

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