The significance of neutrophil-lymphocyte ratio, platelet-lymphocyte ratio and lymphocyte-monocyte ratio in predicting peripheral arterial disease, peripheral neuropathy, osteomyelitis and amputation in diabetic foot infection

Abstract

Aims: The aim of the study was to evaluate the value of neutrophil to lymphocyte ratio (NLR), platelet to lymphocyte ratio (PLR) and lymphocyte to monocyte ratio (LMR) in predicting peripheral arterial disease, peripheral neuropathy, osteomyelitis and need for amputation in diabetic foot infection (DFI).

Methods: A total of 280 patients were analyzed retrospectively. The NLR, PLR and LMR were evaluated statistically in DFI.

Results: A total of 280 patients were enrolled in the study. PLR was significantly higher in osteomyelitis and NLR was found higher in peripheral arterial disease in DFI (p = 0.008, p = 0.007). A PLR of >187.3 was calculated as the cut off value with 67.9% sensitivity and 59.1% specificity in predicting osteomyelitis. A NLR of >6.5 was calculated as the cut off with 53.3% sensitivity and 63% specificity in predicting peripheral arterial disease. NLR, PLR and LMR had a predictive value in predicting amputation in DFI (p < 0.001, p < 0.001, p = 0.006). NLR and PLR were higher in patients who required amputation than in patients who required debridement/drainage (p < 0.001, p = 0.002). NLR was significant in determining amputation levels (minor or major) (p = 0.013).

Conclusions: NLR can predict peripheral arterial disease and elevated PLR can predict osteomyelitis in DFI. NLR, PLR and LMR are predictive of the need for amputation in DFI.

Keywords: Diabetes; Foot; Infection; Lymphocyte; Ratio.