Kumar Ritesh, Singh Surya K, Agrawal Neeraj K, Kumar Ujwal, Kumar Subhash, C Supreeth, Bishnoi Avina
Department of Endocrinology and Metabolism, Institute of Medical Sciences, Banaras Hindu University, Varanasi, IND.
Department of Urology, Institute of Medical Sciences, Banaras Hindu University, Varanasi, IND.
Cureus. 2023 Jul 15;15(7):e41922. doi: 10.7759/cureus.41922. eCollection 2023 Jul.
We aim to determine the prevalence of anemia in hospitalized patients with diabetic foot ulcers (DFUs) and estimate the relationship between the severity of anemia and diabetic foot ulcer.
We retrospectively collected and evaluated the data of 323 patients hospitalized with diabetic foot ulcer (DFU). We included 299 type 2 diabetic patients with foot ulcers of neuropathic or neuroischemic nature with infection. Anemia was defined based on World Health Organization (WHO) criteria, and the severity of DFU was classified in University of Texas (UT) grades.
Anemia was detected in 94.3% of DFU, and the prevalence of mild, moderate, and severe anemia was 16.7%, 55.7%, and 27.6%, respectively. There was a significant difference in the mean hemoglobin (Hb) levels among the patients with varying grades of severity of DFU (1B: Hb=10.17±2.08 gm/dL, 2B: Hb=9.27±2.04 gm/dL, 3B: Hb=8.03±1.829 gm/dL; p value=<0.0001). The iron study was available in 141 (47.15%) patients and was suggestive of anemia of chronic disorder (mean serum iron=40.22±23.81 mcg/dL, mean total iron-binding capacity (TIBC)=239.34±67.24 mcg/dL, mean ferritin=378.05±141.337 ng/mL). TIBC significantly decreased (1B=262.13±61.05, 2B=233.65±71.26, 3B=222.43±74.18; p=0.04), and ferritin significantly increased (1B=309.9±70.76, 2B=351.73±94.22, 3B=488.58±170.4; p<0.0001) with increasing DFU severity. Hemoglobin was significantly decreased at the time of discharge in comparison to that at admission (9.3±2.1 gm/dL versus 8.8±1.5 gm/dL; p value=0.01). Red blood cell (RBC) counts, mean corpuscular volume (MCV), mean corpuscular hemoglobin concentration (MCHC), lymphocyte counts, albumin, calcium, and high-density lipoprotein (HDL) significantly decreased with the increase of DFU severity. The duration of hospitalization, total leucocyte counts, neutrophil counts, and neutrophil-to-lymphocyte ratio (NLR) increased with the severity of DFU.
The prevalence of anemia was very high in DFU and more than three-fourths of the patients had moderate to severe anemia. The severity of anemia was associated with the severity of DFU. The most common cause of anemia was anemia of chronic disorder secondary to diabetic foot infection. During the period of hospitalization, hemoglobin decreased despite improvement in DFU infection.
我们旨在确定糖尿病足溃疡（DFU）住院患者贫血的患病率，并评估贫血严重程度与糖尿病足溃疡之间的关系。
我们回顾性收集并评估了323例因糖尿病足溃疡（DFU）住院患者的数据。我们纳入了299例患有神经性或神经缺血性足部溃疡且伴有感染的2型糖尿病患者。贫血根据世界卫生组织（WHO）标准定义，DFU的严重程度按照德克萨斯大学（UT）分级。
94.3%的DFU患者检测出贫血，轻度、中度和重度贫血的患病率分别为16.7%、55.7%和27.6%。不同严重程度等级的DFU患者平均血红蛋白（Hb）水平存在显著差异（1B级：Hb = 10.17±2.08 g/dL，2B级：Hb = 9.27±2.04 g/dL，3B级：Hb = 8.03±1.829 g/dL；p值<0.0001）。141例（47.15%）患者进行了铁代谢检查，提示为慢性病性贫血（平均血清铁 = 40.22±23.81 μg/dL，平均总铁结合力（TIBC）= 239.34±67.24 μg/dL，平均铁蛋白 = 378.05±141.337 ng/mL）。随着DFU严重程度增加，TIBC显著降低（1B级 = 262.13±61.05，2B级 = 233.65±71.26，3B级 = 222.43±74.18；p = 0.04），铁蛋白显著升高（1B级 = 309.9±70.76，2B级 = 351.73±94.22，3B级 = 488.5±170.4；p<0.0001）。与入院时相比，出院时血红蛋白显著降低（9.3±2.1 g/dL对8.8±1.5 g/dL；p值 = 0.01）。随着DFU严重程度增加，红细胞（RBC）计数、平均红细胞体积（MCV）、平均红细胞血红蛋白浓度（MCHC）、淋巴细胞计数、白蛋白、钙和高密度脂蛋白（HDL）显著降低。住院时间、白细胞总数、中性粒细胞计数和中性粒细胞与淋巴细胞比值（NLR）随DFU严重程度增加而增加。
DFU患者贫血患病率非常高，超过四分之三的患者患有中度至重度贫血。贫血严重程度与DFU严重程度相关。贫血最常见的原因是糖尿病足感染继发的慢性病性贫血。在住院期间，尽管DFU感染有所改善，但血红蛋白仍降低。
