Hemostatic state augmented with platelet indices among Sudanese diabetic septic foot

Abstract

BackgroundDiabetes mellitus is a very rampant metabolic disorder, particularly type II. It has many complications such as the septic foot. Diabetic septic foot (DSF) patients are at high risk for coagulation abnormalities as well as surgical hazards. Owing to the potential sequelae of coagulation and vascular abnormalities, this work aimed at studying the hemostatic state and platelet indices in diabetes type II patients with septic foot.MethodsA case-control study was conducted during the period from July to September 2017 at Dr. Awaad medical center, Red Sea State, Sudan. 57 diabetic patients with septic foot, aged between 17 and 78 years along with 57 non-diabetic subjects as control were enrolled. Sociodemographic data were collected using a structured questionnaire. Venipuncture blood was taken with necessary safety measures. Diabetes profile, coagulation studies as well as platelet indices were estimated. Data was analyzed using SPSS version 24.0 for windows. Ethical approval was considered and written consent from each participant was obtained.ResultsThe mean age of diabetic patients with septic foot and healthy controls were 48.49 ± 15.8 and 32.77 ± 14.0, respectively. The duration of the diabetes onset was 10.43 ± 9.5 years. Plasma prothrombin time (PT) value (12.61 ± 2.6 vs 13.67 ± 1.5, P < 0.009) was found to be significantly shorter in DSF compared to control. Plasma activated partial thromboplastin time (APTT) value was significant in diabetic septic foot (32.64 ± 5.2 vs 28.49 ± 4.13, P < 0.000), and thrombin time (TT) did not changed in DSF. Mean platelet volume (MPV), platelet distribution width (PDW), and platelet large cell ratio (P-LCR) values were significantly decreased in DSF compared to control (P < 0.013, 0.034, and 0.020, respectively). PDW values were positively correlated with PT, APTT, and D-Dimer (DD) (r = 0.28/p < 0.003, r = 0.29/p < 0.029, and r = 0.32/p < 0.016, respectively). FVIII activity (121.86 ± 174.4 vs 98.66 ± 31.83, P < 0.951) was insignificant with DSF, as the DD was also insignificant (P < 0.081).ConclusionDiabetes mellitus is associated with prothrombotic tendency. Hypercoagulable state in DSF is indicated by shortened PT finding. PDW is a manifesting evidence that proves the presence of more reactive and aggregable platelets in DSF patients.

Risk Factors for Major Amputation in Diabetic Foot Ulcer Patients

“…38 Bashir's study indicated that APTT value was significant in diabetic septic foot patients compared to non-diabetic septic foot patients (32.64 ± 5.2 versus 28.49 ± 4.13, p < 0.01), and the author held that APTT was associated with prothrombotic state and hypercoagulability in patients with diabetic septic foot. 39 Some diseases that may prolong APTT value, such as liver disease, vitamin K deficiency, sepsis, and disseminated intravascular coagulation and so on, were not found in the case data. We did the correlation test between APTT and other variables, and the results showed that WBC, Hb, ALB were correlated with APTT, which was statistically significant as shown in the figure below, but the correlation was slight (r = 0.155, r = 0.252, r = 0.247).…”

Prevalence of diabetic foot amongst adults with diabetes mellitus in northern Sudan: A cross‐sectional study

“…30 Impairment of coagulation, fibrinolysis and platelet function increases the risks of thrombogenesis, atherosclerosis progression and plaque formation. 20,31 In this study, type 2 DM patients were at higher risk of DF than type 1 DM patients. This is in line with clinical studies showing a high susceptibility of type 2 DM patients to DF.…”

APTT (Activated Partial Thromboplastin Time) dan (Prothrombin Time) pada Penderita Diabetes Melitus Tipe 2 di RSUD dr. Doris Sylvanus Palangkaraya

“…Beberapa penelitian melaporkan adanya insignifiknasi pada FVIII antara DMT2 dengan individu normal yang sehat. Peningkatan FVIII lebih biasanya disertai pula dengan peningkatan konsentrasi VWF (Bashir and Ali, 2018).…”