Analysis of routine blood markers for predicting amputation/re‐amputation risk in diabetic foot

Abstract

Diabetic foot is challenging progressive disease which requires multisystemic control. Neuropathy, arteriopathy, and cellular responses should treated collaboratively. Despite all medical advances, diabetic foot can highly resulted with amputation and also re‐amputation can be required because of failed wound healing. In this study, we aimed to investigate the relation between blood parameters and amputation events. Diabetic 323 patients include to the study who referred to orthopaedic clinic for amputation. Amputation levels (amputation levels phalanx, metatarsal, lisfranc, syme, below knee, knee‐disarticulation, above‐knee amputation) and re‐amputations recorded and compared with routine blood parameters. Re‐amputation was observed at 69 patients. The significant difference detected between lower albumin, higher HbA1c, higher CRP levels (P < 0.05) in regards to gross amputation levels, and increased wound depth. Furthermore, lower albumin levels and higher levels of WBC, HbA1c, CRP, and Creatinine were detected in re‐amputation levels. Especially, HbA1c, CRP, and Creatinine levels were found as upper bound of reference line for re‐amputation. The statistically optimal HbA1c cutoff point for diabetes was ≥7.05%, with a sensitivity of 86% and a specificity of 59%. In according to our results, simple blood parameters can be useful for observing the progress of amputation in diabetic foot. Particularly, lower albumin, and higher HbA1c, CRP, and Creatinine levels detected as related with poor prognosis. Besides, screening of HbA1c level seems to be highly sensitive for detecting of re‐amputation possibility.

Does re-amputation following lower extremity amputation in diabetic or dysvascular patients negatively affect survival?

“…2-2590 days were reported in the literature from the first operation to reoperation [17]. The general opinion is that these patients should be closely followed-up within the first six months [20].Although, various risk factors for reoperation (coronary artery disease, chronic kidney failure, low albumin levels, low lymphocyte count, anemia) were reported [13,16,17,21,22], we did not find a statistically significant relationship between the risk factors and re-operation in this study. This may be explained by the fact that the majority of our patients have already these risk factors.…”

“…Patients who should undergo amputation at the possible distal level to avoid the impairment of their quality of life and functionality. Many factors affect wound healing in patients after amputation surgery [14,[16][17][18][19]. The median period from the initial surgery to the second surgery was six weeks in our study.…”

Inflammatory and Prothrombotic Biomarkers, DNA Polymorphisms, MicroRNAs and Personalized Medicine for Patients with Peripheral Arterial Disease

“…In diabetic patients, amputations re-amputations represent frequent complication. Guelcu et al showed that CRP, together with lower albumin, higher HbA1c, and higher creatinine levels is associated with poor prognosis and re-amputation [ 38 ]. Diabetes induces dysregulation of miRNA expression that is associated with the development of macrovascular complications, including PAD [ 39 ] and dysregulates miRNAs expression related to atherosclerosis [ 40 ].…”

Prognostic Value of Histological and Immunohistochemical Data in Diabetic Foot Ulcers

“…The number of such patients is rapidly increasing, as is the number of complications associated with the disease [ 5 , 6 , 7 , 8 , 9 ]. One of these complications, which permanently disables a person and is accompanied by the appearance of nonhealing or poorly healing ulcers on the distal parts of the lower extremities, is known in the medical literature as diabetic foot ulcers or diabetic foot syndrome (DFS) [ 10 , 11 , 12 , 13 ], which is the leading cause of non-traumatic lower extremity amputation [ 14 , 15 , 16 , 17 , 18 ].…”