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Preoperative PLR and NLR values as predictors of mortality in diabetic foot amputations

Background: The incidence of lower extremity complications associated with diabetes mellitus has been increasing as the number of patients with diabetes rises. Amputation is the most critical complication. The aim of this study was to elucidate the correlations of the preoperative platelet/lymphocyte ratio (PLR) and neutrophil/lymphocyte ratio (NLR) with wound complications, re-amputations, and mortality.

Materials and Methods: This study included 258 patients who underwent lower extremity amputations due to diabetes (152 with below-knee amputations and 106 with above-knee amputations). The preoperative PLR, NLR, and hemoglobin concentration were calculated. Postoperative deaths were classified as those that occurred within the first 6 months (Group I), from 6 months to 1 year (Group II), from 1 to 3 years (Group III), and beyond 3 years (Group IV). Age, sex, re-amputation, and wound complications were investigated.

Results: The amputation level and mortality rate were significantly correlated (p=0.017). No significant difference was found among Groups I to IV in either the haemoglobin concentration (9.4, 10.1, 10.1, and 10.7 g/dl, respectively; p=0.709) or PLR (247.7, 222.3, 229.4, and 195.0, respectively; p=0.678). The NLR was significantly higher in Group I (9.2) than in Groups II to IV (5.5, 6.3, and 5.6, respectively; p=0.012).

Conclusion: Patients with a high preoperative NLR and above-knee amputation due to diabetes had a higher mortality rate. The PLR is not a suitable prognostic marker for patients undergoing amputation due to diabetes.

Author(s): Hasan Gocer, Ismail Buyukceren, Sina Coskun, Davut Keskin, Nevzat Dabak