DOI: https://doi.org/10.22263/2312-4156.2025.3.26
Y.S. Ladzik, S.M. Yermashkevich
Hematological risk indicators in surgical treatment of diabetic foot syndrome
Vitebsk State Order of Peoples’ Friendship Medical University, Vitebsk, Republic of Belarus
Vestnik VGMU. 2025;24(3):26-38.
Abstract.
Objectives. To determine hematological risk indicators associated with the surgical treatment results of diabetic foot syndrome (DFS).
Material and methods. A retrospective analysis of examination and treatment results in 452 patients with DFS was performed. The surgical activity was 60.0%. Local interventions on the foot were performed in 48.2% of patients, of which 14.7% required a series of additional local interventions, and in 6.4% one had ultimately to resort to «high» amputation of the lower limb. Primary «high» amputations of the lower limb were used in 11.7% of cases, 26% of which had complications on the part of the stump, for which the patients underwent surgery.
Results. In the complete blood count (CBC) the hematological risk indicators for performing additional operations on the foot after local interventions in case of DFS are the folloing: erythrocyte sedimentation rate >60 mm/hour, neutrophil-lymphocyte ratio (NLR) >4,29 units or infection index (II) ≤0,23 units, leukocyte intoxication index of Ya.Ya. Kalf-Kalif (LII) >1,23 units, leukocyte shift index according to N.I. Yabuchinsky (ISL) >0,08 units; performing HALL after local interventions on the foot: ISL >0,10 units; performing primary HALL: erythrocytes ≤4,19×1012/l, hemoglobin ≤111 g/l, MCH ≤27,6 pg, leukocytes >12.80×109/l, NLR >4,24 units, II ≤0,23 units, LII >2,64 units; performing HALL in surgical treatment: erythrocytes ≤4,06×1012/l, hemoglobin ≤111 g/l, leukocytes >12,50×109/l, NLR >4,24 units, LII >1,81 units, ISL >0,10 units, II ≤0,23 units.
Conclusions. The obtained findings can be used to predict the results and determine rational tactics for surgical treatment in patients with DFS.
Keywords: diabetic foot syndrome, surgery, local interventions on the foot, amputation, reamputation, risk factors, prognosis.
References
1. Ros assots endokrinologov; Dedov II, Melnichenko GA, red. Endocrinology: nats ruk. 2-e izd, pererab i dop. Moscow, RF: GEOTAR-Media; 2021. 1112 р. (In Russ.).
2. Bandyk DF. The diabetic foot: pathophysiology, evaluation, and treatment. Seminars in Vascular Surg. 2018 Jun-Dec;31(2-4):43-48. doi: http://dx.doi.org/10.1053/j.semvascsurg.2019.02.001
3. van Battum P, Schaper N, Prompers L, Apelqvist J, Jude E, Piaggesi A, et al. Differences in minor amputation rate in diabetic foot disease throughout Europe are in part explained by differences in disease severity at presentation. Diabetic Medicine. 2011 Feb;28(2):199-205. doi: http://dx.doi.org/10.1111/j.1464-5491.2010.03192.x
4. Sen P, Demirdal T, Emir B. Meta-analysis of risk factors for amputation in diabetic foot infections. Diabetes Metabolism Research and Reviews. 2019 Oct;35(7):e3165. doi: http://dx.doi.org/10.1002/dmrr.3165
5. Eroshkin SN, Bulavkin VP. Diabetic foot syndrome: clinic, diagnosis, treatment: posobie. Vitebsk, RB: VGMU; 2016. 56 р. (In Russ.).
6. Kosinets AN, Zenkov AA. Diabetic foot syndrome. Vitebsk, RB: VGMU; 2003. 214 р. (In Russ.).
7. Ignatovich IN, Kondratenko GG. Diabetic foot surgery: ucheb-metod posobie. Minsk, RB: BGMU; 2013. 57 р. (In Russ.).
8. Strokov IA, Fokina AS. New treatment options for diabetic complications. Russkii Meditsinskii Zhurnal. 2012;(20):996-1000. (In Russ.).
9. Esipov AV, Alekhnovich AV, Musailov VA, Markevich PS, Potapov VA. Actual problems of diagnostics of diabetic foot syndrome. Vestnik Natsional'nogo Mediko-khirurgicheskogo Tsentra im NI Pirogova. 2023;18(2):115-120. (In Russ.). doi: http://dx.doi.org/10.25881/20728255_2023_18_2_115
10. Nabiev MKh, Abdulloev DA, Yusupova ShYu, Boronov TB. Rational surgical tactics in choosing the level of amputation in patients with complicated forms of diabetic foot syndrome. Vestnik Poslediplomnogo Obrazovaniya v Sfere Zdravookhraneniya. 2018;(2):58-63. (In Russ.).
11. Winell K, Venermo M, Ikonen T, Sund R. Indicators for comparing the incidence of diabetic amputations: a nationwide population-based register study. European Journal of Vascular and Endovascular Surgery. 2013 Nov;46(5):569-574. doi: http://dx.doi.org/10.1016/j.ejvs.2013.07.010
12. Bobrov MI, Zhivtsov OP, Samoylov DV, Shatalin AE, Orlinskaya NYu, Volovik MG, i dr. High lower extremity amputations. Rany i Ranevye Infektsii. Zhurnal im prof BM Kostyuchenka. 2019;6(3): 6-23. (In Russ.). DOI: HTTP://DX.DOI.ORG/10.25199/2408-9613-2019-6-3-6-23
13. Frantsuzov VN, Khaykina EV, Reshedko GK. Diagnosis and management of surgical foot infections in diabetes mellitus. Klinicheskaya Mikrobiologiya i Antimikrobnaya Khimioterapiya. 2005;7(3):235-244. (In Russ.).
14. Siplivyy VA, Kon EV, Evtushenko DV. Use of leukocyte indices to predict the outcome of peritonitis. Klinichna Khirurgiya. 2009;(9):21-26. (In Russ.).
15. Naz I, Walters E, Akbari CM, Attinger CE, Kim PJ. Noninvasive vascular assessment of lower extremity wounds in diabetics: are we able to predict perfusion deficits? Surgical Technology International. 2017 Oct:31:66-74.
16. Stavchikov EL, Zinovkin IV, Marochkov AV. Blood platelet levels in patients with diabetic foot syndrome as a criterion of lesion severity. Zhurnal Grodnenskogo Gosudarstvennogo Meditsinskogo Universiteta. 2022;20(1):50-54. (In Russ.). doi: http://dx.doi.org/10.25298/2221-8785-2022-20-1-50-54
17. Aragón-Sánchez J, Víquez-Molina G, López-Valverde ME, Aragón-Hernández J, Rojas-Bonilla JM, Murillo-Vargas C. Clinical, microbiological and inflammatory markers of severe diabetic foot infections. Diabetic Medicine. 2021 Oct;38(10):e14648. doi: http://dx.doi.org/10.1111/dme.14648
18. Sen P, Demirdal T. Predictive ability of LRINEC score in the prediction of limb loss and mortality in diabetic foot infection. Diagnostic Microbiology and Infectious Disease. 2021 May;100(1):115323. doi: http://dx.doi.org/10.1016/j.diagmicrobio.2021.115323
19. Yapici O, Berk H, Oztoprak N, Seyman D, Tahmaz A, Merdin A. Can ratio of neutrophil-to- lymphocyte count and erythrocyte sedimentation rate in diabetic foot infection predict osteomyelitis and/or amputation? Hematology Reports. 2017 Feb;9(1):6981. doi: http://dx.doi.org/10.4081/hr.2017.6981
20. Serban D, Papanas N, Dascalu A-M, Kempler P, Raz I, Rizvi AA, et al. Significance of neutrophil to lymphocyte ratio (NLR) and platelet lymphocyte ratio (PLR) in diabetic foot ulcer and potential new therapeutic targets. The International Journal of Lower Extremity Wounds. 2021 Jun. Vol. 23, № 2. P. 205–216. DOI: HTTP://DX.DOI.ORG/10.1177/15347346211057742
Submitted 01.04.2025
Accepted 13.06.2025
Information about authors:
Yulia S. Ladzik – postgraduate, lecturer of the Chair of Hospital Surgery with the course of the Faculty for Advanced Training & Retraining, Vitebsk State Order of Peoples’ Friendship Medical University, https://orcid.org/0000-0002-5563-0275, e-mail: Этот адрес электронной почты защищён от спам-ботов. У вас должен быть включен JavaScript для просмотра.;
S.M. Yermashkevich – Candidate of Medical Sciences, associate professor of the Chair of Hospital Surgery with the course of the Faculty for Advanced Training & Retraining, Vitebsk State Order of Peoples’ Friendship Medical University, https://orcid.org/0000-0002-0866-9070
