Original Research

Preoperative Platelets to Lymphocyte Ratio in Diabetic Foot A Cost Effective Prognostic Indicator

Anam Fatima Bangash1
Mayo Hospital Lahore
Waqar Ali1
Mayo Hospital Lahore
Kiran Riaz1
Mayo Hospital Lahore
Nasir Farooq Butt1
Mayo Hospital Lahore
Noor Shahid2
Lahore College for Women
Muhammed Sohail Asghar1
Mayo Hospital Lahore

✉ Correspondence: Anam Fatima Bangash Email: sunflora88@gmail.com

DOI https://doi.org/10.70302/jpsim.v6i2.2534
Volume: 6, Issue 2 Pages: 180–184 Published: 05 Jun 2025
Received: 07 Jan 2025 Revised: 25 Feb 2025 Accepted: 28 Apr 2025 Published Online: 05 Jun 2025

Abstract

Objective

To study prognostic value of pre-operative platelets to lymphocyte ratio in diabetic foot patients who underwent amputation.

Methods

This study was conducted in the surgical units of Mayo Hospital Lahore. One hundred and eighty four patients were included in the study. Data was obtained from records of patients admitted between July 2020 to July 2021. Platelet to lymphocyte ratio was noted from investigations done preoperatively. Outcome of patients was noted. Diabetic foot ulcers were classified using Wagner classification. A receiver operator curve was constructed and area under the curve was calculated. A suitable cut-off value of platelet to lymphocyte ratio was decided using the curve. Sensitivity and specificity of the cut off value as a prognostic indicator was compared between discharged and expired groups of patients using independent sample t-test.

Results

All-cause mortality was higher in patients with high platelet to lymphocyte ratio. Area under the receiver operator curve was 0.56. Cut off value of platelet to lymphocyte ratio 244.95 calculated from receiver operator curve was found to have sensitivity of 61.8% and specificity of 53.3%. Out of 184 patients 141 (76.6%) were males and 43 (23.4%) were females with a mean age of 54.9 ± 10.47 years. One hundred and fifty patients ( 81.5%) were discharged and the remaining expired

Conclusions

Preoperative platelet to lymphocyte ratio can be used as a predictive biomarker of mortality in patients with diabetic foot ulcer undergoing amputation.

Keywords
Diabetic Foot. Lymphocytes Platelets.

How to Cite This Article

Bangash AF, Ali W, Riaz K, Butt NF, Shahid N, Asghar MS. Preoperative Platelets to Lymphocyte Ratio in Diabetic Foot A Cost Effective Prognostic Indicator. J Pak Soc Intern Med. 2025;6(2):180–184. doi:10.70302/jpsim.v6i2.2534

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Conflict of Interest

All authors declare no competing interests.

Disclosed in accordance with ICMJE and COPE guidelines.

Funding

No specific funding was received for this research.

Funder information follows the Crossref Funder Registry standard.

References

  1. Talukder A, Hossain Z. Prevalence of Diabetes Mellitus and Its Associated Factors in Bangladesh: Application of Two-level Logistic Regression Model. Sci Rep. 2020 24;10(1):10237.
  2. Aynalem SB, Zeleke AJ. Prevalence of Diabetes Mellitus and Its Risk Factors among Individuals Aged 15 Years and Above in Mizan-Aman Town, Southwest Ethiopia, 2016: A Cross Sectional Study. Int J Endocrinol. 2018;2018(1):9317987.
  3. Deshpande AD, Harris-Hayes M, Schootman M. Epidemiology of diabetes and diabetes-related complications. Phys Ther. 2008;88(11):1254-64.
  4. World Health Organization. Diabetes. [Updated 2021, Cited 2024]. Available from; https://www.who.int/news-room/fact-sheets/detail/diabetes
  5. Papatheodorou K, Banach M, Bekiari E, Rizzo M, Edmonds M. Complications of Diabetes 2017. J Diabetes Res. 2018; doi: 10.1155/2018/3086167. doi:10.1155/2018/3086167
  6. Abdissa D, Adugna T, Gerema U, Dereje D. Prevalence of Diabetic Foot Ulcer and Associated Factors among Adult Diabetic Patients on Follow-Up Clinic at Jimma Medical Center, Southwest Ethiopia, 2019: An Institutional-Based Cross-Sectional Study. J Diabetes Res. 2020;2020(1):4106383.
  7. Pendsey SP. Understanding diabetic foot. Int J Diabetes Dev Ctries. 2010;30(2):75.
  8. Farooque U, Lohano AK, Hussain Rind S, Rind Sr MS, Karimi S, Jaan A, et al. Correlation of Hemoglobin A1c With Wagner Classification in Patients With Diabetic Foot. Cureus. 2020;12(7): e9199.
  9. Jeyaraman K, Berhane T, Hamilton M, Chandra AP, Falhammar H. Mortality in patients with diabetic foot ulcer: a retrospective study of 513 cases from a single Centre in the Northern Territory of Australia. BMC Endocr Disord. 2019;19(1):1-7.
  10. Santra S, Rawat A, Pattarayan D, Roy S. Chronic infection and inflammation: Hallmarks of diabetic foot ulcers. Wound Healing, Tissue Repair, and Regeneration in Diabetes. 2020. p. 39-47
  11. Hadavand F, Amouzegar A, Amid H. Procalcitonin, Erythrocyte Sedimentation Rate and C - reactive Protein in Predicting Diabetic Foot Ulcer Characteristics; a Cross Sectional Study. Arch Acad Emerg Med. 2019;7(1):37.
  12. Vatankhah N, Jahangiri Y, Landry GJ. Predictive value of neutrophil-to-lymphocyte ratio in diabetic wound healing. J Vasc Surg. 2017 Feb 1;65(2):478-83.
  13. Eren MA, Güneş AE, Kırhan İ, Sabuncu T. The role of the platelet-to-lymphocyte ratio and neutrophil-to-lymphocyte ratio in the prediction of length and cost of hospital stay in patients with infected diabetic foot ulcers: A retrospective comparative study. Acta Orthop Traumatol Turc. 2020 Mar;54(2):127.
  14. Sarmah HK, Hazarika BB. Importance of the size of Sample and its determination in the context of data related to the schools of greater Guwahati. Bull Gauhati Univ Math Assoc. 2012;12(1):55-76.
  15. Mineoka Y , Ishii M, Hashimoto Y, Yamashita A, Nakamura N, Fukui M. Platelet to lymphocyte ratio correlates with diabetic foot risk and foot ulcer in patients with type 2 diabetes. Endocr J. 2019;66(10):905-913
  16. Chen W, Chen K, Xu Z, Hu Y, Liu Y, Liu W, et al. Neutrophil-to-Lymphocyte Ratio and Platelet-to-Lymphocyte Ratio Predict Mortality in Patients with Diabetic Foot Ulcers Undergoing Amputations. Diabetes Metab Syndr Obes. 2021;14(5):821-829
  17. Serban D, Papanas N, Dascalu AM, 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. Int J Lower Extremity Wound. 2024 Jun;23(2):205-16.
  18. Balta S, Ozturk C. The platelet-lymphocyte ratio: A simple, inexpensive and rapid prognostic marker for cardiovascular events. Platelets. 2015;26(7):680-1

Reference list indexed for Google Scholar and ResearchGate. DOI links resolve via doi.org.

CC BY CC BY 4.0 This article is published under the Creative Commons Attribution 4.0 International License. May be shared and adapted with attribution. © 2025 Journal of Pakistan Society of Internal Medicine.
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