Pre-operative Neutrophil-Lymphocyte and Platelet-Lymphocyte Ratios as Predictors of Morbidity and Mortality in Diabetic Foot Infection Amputation Patients
Background: Diabetic foot infection is a complication of uncontrolled diabetes. Some cases require amputation to avoid the spread of infection; however, this can also lead to poor outcomes. Inflammatory markers, such as neutrophil-lymphocyte ratio (NLR) and platelet-lymphocyte ratio (PLR), have bee...
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Philippine Orthopaedic Association, Inc.
2025-01-01
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| Series: | Philippine Journal of Orthopaedics |
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| Online Access: | https://philjorthopaedics.org/index.php/pjo/article/view/10821 |
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| author | Joseph Paulo Sales Emiliano Tablante |
| author_facet | Joseph Paulo Sales Emiliano Tablante |
| author_sort | Joseph Paulo Sales |
| collection | DOAJ |
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Background: Diabetic foot infection is a complication of uncontrolled diabetes. Some cases require amputation to avoid the spread of infection; however, this can also lead to poor outcomes. Inflammatory markers, such as neutrophil-lymphocyte ratio (NLR) and platelet-lymphocyte ratio (PLR), have been explored as predictors of outcomes following amputation; however, only a few published studies are available.
Objective: The study aimed to determine the diagnostic value of pre-operative neutrophil-lymphocyte and platelet-lymphocyte ratios in predicting in-hospital morbidity and mortality among diabetic foot infection patients who underwent amputation in a tertiary government hospital.
Methodology: This retrospective cohort study included a total of 535 diabetic foot ulcer patients who underwent amputation at a tertiary government hospital. Data was collected via medical chart review. Complete blood count (CBC) parameters closest to the time of amputation were obtained to calculate the neutrophil-lymphocyte and platelet-lymphocyte ratios. Stata software was used for data processing and analysis.
Results: Only 10.28% of patients experienced in-hospital morbidity and/or mortality. Based on Youden’s index, the optimal cutoff points of neutrophil-lymphocyte and platelet-lymphocyte ratios were 7.27 and 32.40, respectively. Both markers showed 98% sensitivity in predicting the outcome. Specificity was 99% for the neutrophil-lymphocyte ratio and 93% for the platelet-lymphocyte ratio. Accuracy parameters remained high when morbidity and mortality were analyzed separately, and subgroup analyses by major and minor amputations were performed.
Conclusion: Neutrophil-lymphocyte and platelet-lymphocyte ratios accurately predict in-hospital morbidity and mortality among diabetic foot infection patients who underwent amputation. The low cost and wide availability of a CBC make NLR and PLR valuable options in low-resource settings. Future studies should explore these markers' utility in predicting long-term outcomes after amputation.
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| format | Article |
| id | doaj-art-beb1a273f9884fd9a98818fbf68d184c |
| institution | Kabale University |
| issn | 0118-3362 2012-3264 |
| language | English |
| publishDate | 2025-01-01 |
| publisher | Philippine Orthopaedic Association, Inc. |
| record_format | Article |
| series | Philippine Journal of Orthopaedics |
| spelling | doaj-art-beb1a273f9884fd9a98818fbf68d184c2025-01-16T03:55:57ZengPhilippine Orthopaedic Association, Inc.Philippine Journal of Orthopaedics0118-33622012-32642025-01-0110.69472/poai.2025.06Pre-operative Neutrophil-Lymphocyte and Platelet-Lymphocyte Ratios as Predictors of Morbidity and Mortality in Diabetic Foot Infection Amputation PatientsJoseph Paulo Sales0Emiliano Tablante1a:1:{s:5:"en_US";s:37:"Jose R. Reyes Memorial Medical Center";}Jose R. Reyes Memorial Medical Center Background: Diabetic foot infection is a complication of uncontrolled diabetes. Some cases require amputation to avoid the spread of infection; however, this can also lead to poor outcomes. Inflammatory markers, such as neutrophil-lymphocyte ratio (NLR) and platelet-lymphocyte ratio (PLR), have been explored as predictors of outcomes following amputation; however, only a few published studies are available. Objective: The study aimed to determine the diagnostic value of pre-operative neutrophil-lymphocyte and platelet-lymphocyte ratios in predicting in-hospital morbidity and mortality among diabetic foot infection patients who underwent amputation in a tertiary government hospital. Methodology: This retrospective cohort study included a total of 535 diabetic foot ulcer patients who underwent amputation at a tertiary government hospital. Data was collected via medical chart review. Complete blood count (CBC) parameters closest to the time of amputation were obtained to calculate the neutrophil-lymphocyte and platelet-lymphocyte ratios. Stata software was used for data processing and analysis. Results: Only 10.28% of patients experienced in-hospital morbidity and/or mortality. Based on Youden’s index, the optimal cutoff points of neutrophil-lymphocyte and platelet-lymphocyte ratios were 7.27 and 32.40, respectively. Both markers showed 98% sensitivity in predicting the outcome. Specificity was 99% for the neutrophil-lymphocyte ratio and 93% for the platelet-lymphocyte ratio. Accuracy parameters remained high when morbidity and mortality were analyzed separately, and subgroup analyses by major and minor amputations were performed. Conclusion: Neutrophil-lymphocyte and platelet-lymphocyte ratios accurately predict in-hospital morbidity and mortality among diabetic foot infection patients who underwent amputation. The low cost and wide availability of a CBC make NLR and PLR valuable options in low-resource settings. Future studies should explore these markers' utility in predicting long-term outcomes after amputation. https://philjorthopaedics.org/index.php/pjo/article/view/10821neutrophil-lymphocyte ratioplatelet-lymphocyte ratiodiabetic foot infectionmorbiditymortalityre-operation |
| spellingShingle | Joseph Paulo Sales Emiliano Tablante Pre-operative Neutrophil-Lymphocyte and Platelet-Lymphocyte Ratios as Predictors of Morbidity and Mortality in Diabetic Foot Infection Amputation Patients Philippine Journal of Orthopaedics neutrophil-lymphocyte ratio platelet-lymphocyte ratio diabetic foot infection morbidity mortality re-operation |
| title | Pre-operative Neutrophil-Lymphocyte and Platelet-Lymphocyte Ratios as Predictors of Morbidity and Mortality in Diabetic Foot Infection Amputation Patients |
| title_full | Pre-operative Neutrophil-Lymphocyte and Platelet-Lymphocyte Ratios as Predictors of Morbidity and Mortality in Diabetic Foot Infection Amputation Patients |
| title_fullStr | Pre-operative Neutrophil-Lymphocyte and Platelet-Lymphocyte Ratios as Predictors of Morbidity and Mortality in Diabetic Foot Infection Amputation Patients |
| title_full_unstemmed | Pre-operative Neutrophil-Lymphocyte and Platelet-Lymphocyte Ratios as Predictors of Morbidity and Mortality in Diabetic Foot Infection Amputation Patients |
| title_short | Pre-operative Neutrophil-Lymphocyte and Platelet-Lymphocyte Ratios as Predictors of Morbidity and Mortality in Diabetic Foot Infection Amputation Patients |
| title_sort | pre operative neutrophil lymphocyte and platelet lymphocyte ratios as predictors of morbidity and mortality in diabetic foot infection amputation patients |
| topic | neutrophil-lymphocyte ratio platelet-lymphocyte ratio diabetic foot infection morbidity mortality re-operation |
| url | https://philjorthopaedics.org/index.php/pjo/article/view/10821 |
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