Farine Francesco, Rapisarda Antonio Maria, Roani Carolina, Giuli Cristina, Comisi Chiara, Mascio Antonio, Greco Tommaso, Maccauro Giulio, Perisano Carlo
Department of Orthopaedics, Fondazione Policlinico Universitario A. Gemelli IRCCS, 00168 Rome, Italy.
Scuola di Specializzazione in Ortopedia e Traumatologia, Università Cattolica del Sacro Cuore, 00168 Rome, Italy.
Biomedicines. 2024 Dec 6;12(12):2775. doi: 10.3390/biomedicines12122775.
: Diabetic foot ulcers are a common complication of diabetes mellitus, often leading to progressive sensory deficits, impaired vascularization, and a predisposition to ulceration and gangrene. Untreated ulcers may cause recurrent infections that endanger a patient's life. Amputation of part of the limb up to a well-vascularized level is one of the treatments employed for untreated ulcers. : Laboratory data were analyzed with the aim of identifying risk factors related to surgical amputation treatment of diabetic foot. We believe it is useful to identify risk factors that can be altered from a reversible condition in the clinical decision-making of treatment, thus manifesting themselves in a timely manner to provide the patient with an alternative to surgical amputation of the lower limb. : Our retrospective study was conducted by the Department of Orthopedics and Traumatology at the Fondazione Policlinico Universitario Agostino Gemelli IRCCS in Rome. We recruited 200 patients who underwent lower limb amputation for diabetic foot between 2017 and 2021 and had blood tests both 30 days and within 5 days before the first surgery. : This case-control study revealed a significant negative correlation between hemoglobin (Hb) levels and the occurrence of leg amputations. In contrast, C-reactive protein (CRP) levels, the neutrophil-to-lymphocyte ratio (NLR), and the platelet-to-lymphocyte ratio (PLR) showed significant positive correlations with leg amputations. A 3-year follow-up of the cases also revealed a significative positive correlation between age, white blood cells (WBC) count, NLR, PLR, and death at 3 years. : Our findings suggested that lower Hb levels and elevated CRP, NLR, and PLR levels in patients with diabetic foot disease may be associated with a higher risk of lower-limb amputation. Unexpectedly, this study also demonstrated that elderly age, WBC, CRP, NLR and PLR levels may be associated with a negative prognosis for these patients. These findings highlighted the importance of monitoring these laboratory values in diabetic patients to identify individuals at higher risk of leg amputations and implement appropriate interventions to prevent or minimize the occurrence of this severe complication.
糖尿病足溃疡是糖尿病的常见并发症，常导致进行性感觉障碍、血管化受损，以及溃疡和坏疽的易感性。未经治疗的溃疡可能引发危及患者生命的反复感染。将肢体部分截除至血管良好的水平是针对未经治疗的溃疡所采用的治疗方法之一。
分析实验室数据旨在确定与糖尿病足手术截肢治疗相关的风险因素。我们认为，在治疗的临床决策中识别可从可逆状态改变的风险因素是有用的，从而能及时显现出来，为患者提供下肢手术截肢的替代方案。
我们的回顾性研究由罗马的圣心天主教大学综合医院阿戈斯蒂诺·杰梅利IRCCS创伤与矫形外科进行。我们招募了200例在2017年至2021年间因糖尿病足接受下肢截肢手术的患者，并在首次手术前30天和5天内进行了血液检测。
这项病例对照研究显示，血红蛋白（Hb）水平与腿部截肢的发生之间存在显著负相关。相比之下，C反应蛋白（CRP）水平、中性粒细胞与淋巴细胞比值（NLR）以及血小板与淋巴细胞比值（PLR）与腿部截肢呈显著正相关。对这些病例进行的3年随访还显示，年龄、白细胞（WBC）计数、NLR、PLR与3年时的死亡之间存在显著正相关。
我们的研究结果表明，糖尿病足病患者较低的Hb水平以及升高的CRP、NLR和PLR水平可能与下肢截肢的较高风险相关。出乎意料的是，这项研究还表明，老年、WBC、CRP、NLR和PLR水平可能与这些患者的不良预后相关。这些发现突出了监测糖尿病患者这些实验室值的重要性，以识别腿部截肢风险较高的个体，并实施适当干预措施以预防或尽量减少这种严重并发症的发生。
