Back to Journals » Diabetes, Metabolic Syndrome and Obesity: Targets and Therapy » Volume 14

Neutrophil-to-Lymphocyte Ratio and Platelet-to-Lymphocyte Ratio Predict Mortality in Patients with Diabetic Foot Ulcers Undergoing Amputations

Authors Chen W, Chen K, Xu Z, Hu Y, Liu Y, Liu W, Hu X, Ye T, Hong J, Zhu H, Shen F

Received 6 November 2020

Accepted for publication 23 January 2021

Published 24 February 2021 Volume 2021:14 Pages 821—829

DOI https://doi.org/10.2147/DMSO.S284583

Checked for plagiarism Yes

Review by Single anonymous peer review

Peer reviewer comments 4

Editor who approved publication: Professor Ming-Hui Zou


Wenwen Chen,1,* Kun Chen,2,* Zhixiao Xu,3 Yepeng Hu,1 Yiying Liu,1 Wenyue Liu,1 Xiang Hu,1 Tingting Ye,1 Jing Hong,1 Hong Zhu,1 Feixia Shen1

1Department of Endocrinology and Metabolism, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, People’s Republic of China; 2Department of Thoracic Surgery, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, People’s Republic of China; 3Department of Pulmonary and Critical Care Medicine, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, People’s Republic of China

*These authors contributed equally to this work

Correspondence: Feixia Shen
Department of Endocrinology and Metabolism, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, People’s Republic of China
Email shenfeixia@wmu.edu.cn

Purpose: Elevated platelet-to-lymphocyte ratio (PLR) and neutrophil-to-lymphocyte ratio (NLR) are associated with poor outcomes in various diseases. The objectives of this study were to explore the utility of PLR and NLR in predicting all-cause mortality in patients with diabetic foot ulcers (DFU) undergoing amputations.
Patients and Methods: A retrospective observational study was performed that included a total of 348 DFU patients undergoing amputations. The primary end-point was all-cause death. According to the PLR and NLR cut-off values, patients were divided into two groups and Kaplan–Meier survival curves were constructed. Multivariable Cox regression was conducted to test the independent predictors of mortality in the study cohort.
Results: All-cause mortality was significantly higher in patients with a high PLR/NLR compared to those with a low PLR/NLR. In the low NLR group, the overall survival (OS) rates at 1, 3, and 5 years after amputation were 96.8%, 84% and 80.1%, respectively (p=0.001). In the high NLR group the corresponding OS rates at 1, 3, and 5 years were 85.2%, 58.6% and 23.9% (p< 0.001). According to the multivariate analysis, age (HR 1.074, 95% CI 1.045– 1.104, p< 0.001), Wagner classification (HR 2.274, 95% CI 1.351– 3.828, p=0.002), PLR (HR 1.794, 95% CI 1.014– 3.174, p=0.045), NLR (HR 2.029, 95% CI 1.177– 3.499, p=0.011), creatinine (HR 1.003, 95% CI 1.001– 1.004, p< 0.001) and direct bilirubin (HR 1.154, 95% CI 1.081– 1.232, p< 0.001) were independent predictors of mortality following amputation.
Conclusion: Postoperative PLR and NLR values may be reliable predictive biomarkers of mortality in patients following amputation for DFU. Considering the high mortality in those patients, the patients with elevated PLR/NLR should be given more intensive in clinical practice.

Keywords: amputation, platelet-to-lymphocyte ratio, PLR, neutrophil-to-lymphocyte ratio, NLR, diabetic foot ulcer, mortality

Creative Commons License This work is published and licensed by Dove Medical Press Limited. The full terms of this license are available at https://www.dovepress.com/terms.php and incorporate the Creative Commons Attribution - Non Commercial (unported, v3.0) License. By accessing the work you hereby accept the Terms. Non-commercial uses of the work are permitted without any further permission from Dove Medical Press Limited, provided the work is properly attributed. For permission for commercial use of this work, please see paragraphs 4.2 and 5 of our Terms.

Download Article [PDF]  View Full Text [HTML][Machine readable]