European Journal of Cardiovascular Medicine

Introduction: One of the most common lower-extremity impediments in people suffering with diabetes-mellitus is foot ulceration. There is an increased risk of amputation and increased mortality rate in patients with foot ulcer. The neutrophil-to-lymphocyte-ratio (NLR) has lately been shown to forecast chemotherapy response in cancer patients, associated with peripheral arterial disease, systemic endothelial dysfunction and cardiovascular diseases. NLR is an useful measure in predicting overall mortality and disease-specific mortality.

Objectives: To evaluate the role of Neutrophil- Lymphocyte Ratio NLR in prognosis of Diabetic-Foot-Ulcer (DFU)

Methodology: The outcomes of diabetic foot ulcers in 100 patients admitted to surgical wards were assessed. Demographic, patient-specific, and wound specific variables as well as NLR at baseline visit were assessed. Outcomes were classified as ulcer healing and chronic ulcer. The data was entered in Microsoft excel and analyzed using SPSS version 16.

Results: The mean (SD) age was 57.1(11.29) years. 58% of subjects were females and 42% were males. The mean (SD) duration of Hypertension was 10.3(3.50) years and that of Diabetes Mellitus was 9.49(3.03) years. 53% had history of trauma, 48(48%) of subjects had pain, 51(51%) had gangrene of foot. The mean (SD) CBP, Neutrophils, Lymphocytes and Neutrophil-Lymphocyte Ratio was 20.24(2.89) per thousand, 94.73(3.21) %, 14.97(3.23) % and 6.65(1.52) respectively. 58% had healing ulcers and 42 had non healing ulcers. 44% of study subjects were having NLR <6 which is normal and 56% had NLR>6 which is abnormal. Among 58 subjects with healing ulcers, 44(75.9%) had NLR<6 and among 42of non-healing ulcers, 42(100%) had NLR >6. This was statistically significant (p value <0.001). The sensitivity of NLR >6 in predicting non-healing ulcer was 100% with a specificity of 75.9%. The positive predictive value was 75% and negative predictive value was 100%. The mean (SD) NLR in healing group was 5.15(0.65) and in non-healing group was 8.205(0.84) and this was statistically significant. This shows an increased NLR has a predisposition towards non-healing chronic ulcers with poor prognosis.

Conclusion: NLR is a good prognostic variable in predicting the outcome of Diabetic foot ulcer. The sensitivity of NLR >6 in predicting non-healing ulcer was 100% with a specificity of 75.9%. The positive predictive value was75% and negative predictive value was 100%.