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Platelet-to-lymphocyte ratio (PLR), platelet-to-hemoglobin ratio (PHR) and systemic immune-inflammation index (SII) as predictive factors of amputation among Diabetic Foot Ulcer (DFU) in Ibnu Sina Gresik Regional Public Hospital, East Java, Indonesia

Abstract

Introduction: Diabetic Foot Ulcer (DFU) is a common complication of Diabetic Mellitus, and predicting the result is a difficult task. In this context, the prediction of clinical outcomes such as amputation or wound healing manages further intervention of life-saving or limb-saving. Therefore, this research aimed to evaluate Platelet-to-Lymphocyte Ratio (PLR), Platelet-to-Hemoglobin Ratio (PHR), and Systemic Immune-inflammation Index (SII) as the predictive factors of amputation.

Method: This retrospective analysis included hospitalized diabetic foot ulcer patients from January to December 2022 in Ibnu Sina Gresik Regional Public Hospital. Pre-treatment inflammatory markers, including the PLR, PHR, and SII, were performed by the Receiver Operating Characteristic (ROC) curve and Youden index to determine AUC and cut-off value, respectively.

Results: This research comprised 58 amputated and 56 non-amputated patients. PLR, PHR and SII of amputation group showed a higher value significantly compared with the non-amputation group (p<0.001). Meanwhile, ROC analysis identified optimal cut-off values for PLR, PHR, and SII as 186.1, 3.09, and 2780.1 based on Youden index, respectively. PLR, PHR, and SII reported 74.1%,74.1%, and 44.8% sensitivity, with 92.9% (AUC = 0.878, p < 0.001), 82.1% (AUC = 0.834, p < 0.001), and 91.1% (AUC = 0.720, p < 0.001) specificity, respectively. Patients with higher PLR faced a 37.3-fold increased risk of amputation compared to those with lower scores (p < 0.001, 95% CI = 11.513-120.626). Higher PHR resulted in a 13.2-fold increased risk of amputation compared to lower scores (p < 0.001, 95% CI = 5.352-32.490), while higher SII obtained an 8.3-fold increased risk compared to lower scores (p < 0.001; 95% CI = 2.888-23.783).

Conclusion: PLR, PHR and SII served as the predictive factors of amputation among diabetic foot ulcer patients.

Section

References

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How to Cite

Pratiwi, M. P., Syakdiyah, N. H. ., & Sintoro, H. P. . (2024). Platelet-to-lymphocyte ratio (PLR), platelet-to-hemoglobin ratio (PHR) and systemic immune-inflammation index (SII) as predictive factors of amputation among Diabetic Foot Ulcer (DFU) in Ibnu Sina Gresik Regional Public Hospital, East Java, Indonesia. Indonesia Journal of Biomedical Science, 18(1), 158–161. https://doi.org/10.15562/ijbs.v18i1.570

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Made Pury Pratiwi
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Noer Halimatus Syakdiyah
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Henry Purbowo Sintoro
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