The Relationship Between Platelet-to-lymphocyte Ratio And Diabetic Foot Ulcer In Patients With Type 2 Diabetes Mellitus

Objective To investigate the correlation between the platelet-to-lymphocyte ratio(PLR)and diabetic foot ulcer(DFU)in patients with type 2 diabetes mellitus(T2DM).Method In this retrospective study,from January 2018 to August 2019,206 patients with T2 DM admitted to the Central Hospital of Wuhan were enrolled into this study,including104 patients with DFU(DFU group)and 102 patients without diabetic foot ulcer(T2DM group).During the same period,90 healthy subjects were randomly screened as normal controls(NC group).The correlation between PLR and DFU in patients with T2 DM was explored by comparing the PLR,participant characteristics,blood routine,blood biochemistry and other indicators of three groups of subjects.Results Compared with the NC group,the smoking rates and mean levels of PLR(119.35±33.84 vs 99.98±20.36;171.19±60.73 vs 99.98±20.36),body mass index,glycated hemoglobin,white blood cell count,and fasting blood glucose were higher in the T2 DM and DFU groups,and the mean levels of high-density lipoprotein and lymphocyte count were lower(all P<0.05).Compared with the T2 DM group,the smoking rate and mean PLR(171.19±60.73vs119.35±33.84),glycated hemoglobin,white blood cell count,and platelet count levels were higher in the DFU group,and the mean levels of total cholesterol and lymphocyte count were lower(all P < 0.05).The PLR of patients with different Wagner DFU grades revealed a statistically significant difference(P<0.001),and the PLR displayed an increasing trend with an increase of the Wagner DFU grade.Spearman’s correlation analysis showed that the PLR,white blood cell count,platelet count,and glycated hemoglobin levels positively correlated with the Wagner DFU grade with statistical significance(all P<0.05),whereas the lymphocyte count and total cholesterol levels negatively correlated with the Wagner DFU grade with statistical significance(all P< 0.05).The PLR showed the highest correlation with the Wagner DFU grade(r=0.504,P<0.001).In all T2 DM patients,whether combined with DFU was used as the dependent variable,according to the logistic regression analysis,the PLR(OR=1.029,95%CI: 1.019～1.039,P<0.001),smoking status(OR=2.022,95%CI: 1.013～4.036,P=0.046),and glycated hemoglobin(OR=1.361,95%CI: 1.144～1.620,P=0.001)were independent risk factors for DFU after adjusting for a variety of traditional factors.In all T2 DM patients,the receiver operating characteristic curve(ROC)analysis of the PLR showed that the area under the curve(AUC)of the PLR for predicting diabetic foot ulcer was 0.776(95%CI: 0.714 ～ 0.839,P < 0.001),and the analysis determined that the optimal critical value of the PLR for predicting DFU was 147.6,with a sensitivity of 65.4% and a specificity of 80.4%.Conclusion The PLR is significantly elevated in patients with DFU and positively correlated with the Wagner DFU grade,which might be a valuable marker for early diagnosis and assessment of severity of DFU.