Prognostic Value of Wagner Grade and Platelet Level in Diabetics with Infected Foot Ulcers After Antibiotic Therapy

Figures & data

Table 1 Baseline Characteristics

Variables	Non-Healed (n=11)	Healed (n=88)	P value
Age, yrs	68.3 ± 10.6	62.3 ± 15.8	0.22
Male	9(81.8)	59(67.0)	0.49
BMI	23.9 ± 3.7	24.6 ± 3.3	0.50
Essential hypertension	7(63.6)	31(35.2)	0.07
Prior CAD	3(27.3)	19(21.6)	0.46
Prior stroke	2(18.2)	14(15.9)	0.56
Prior sepsis	2(18.2)	8(9.1)	0.31
Diabetic fundus disease	0(0.0)	9(10.2)	0.33
Periphery neuropathy	2(18.2)	21(23.9)	0.51
Hypohepatia (mild to moderate)	0(0.0)	4(4.5)	0.62
Hypoproteinemia	1(9.1)	6(6.8)	0.57
Renal insufficiency*	3(27.3)	17(19.3)	0.39
Malignant tumor	1(9.1)	2(2.3)	0.30
Ketoacidosis	1(9.1)	14(15.9)	0.48
Gram negative bacteria	8(72.7)	33(37.5)	0.03
Laboratory data
HbA1c, %	9.83 ± 1.62	9.38 ± 2.17	0.51
Fasting Insulin level, mIU/L median (IQR)	12.10 [5.80, 45.60]	12.10 [8.45, 16.13]	0.38
C-peptide, nmol/L	0.33± 0.16	0.35 ± 0.26	0.19
Wagner grade	3.45 ± 1.13	2.08 ± 0.78	0.002
Total Cholesterol, mmol/L	3.90 ± 0.85	4.03 ± 0.95	0.67
Triglyceride, mmol/L	1.24 ± 0.33	1.23 ± 0.55	0.95
LDL-C, mmol/L	2.09 ± 0.53	2.43 ± 0.78	0.16
HDL-C, mmol/L	1.06 ± 0.46	0.94 ± 0.27	0.41
T3, pmol/L	3.33 ± 0.93	3.56 ± 0.82	0.38
T4, pmol/L	16.24 ± 3.68	14.92 ± 2.32	0.10
TSH, mIU/L	1.49 ± 0.78	2.28 ± 1.56	0.10
WBC, 10^9/L median (IQR)	10.10 [7.80, 13.60]	7.95 [5.85, 10.70]	0.06
Neutrophil, %	83.59 ± 8.57	73.30 ± 11.77	0.006
Lymphocyte, %	9.65± 5.17	18.44 ± 10.23	0.007
Monocyte, %	5.96± 2.14	6.58 ± 2.02	0.35
Eosinophil, % median (IQR)	0.40 [0.01, 0.50]	0.85 [0.20, 1.90]	0.02
Basophil, % median (IQR)	0.20 [0.10, 0.30]	0.20 [0.10, 0.40]	0.43
RBC, 10^12/L	4.32 ± 0.69	4.20 ± 0.70	0.58
Hemoglobin, g/L	131.27 ± 19.08	126.51 ± 21.18	0.48
Hematocrit	38.83 ± 6.45	37.23 ± 5.91	0.40
RDW, %	13.13 ± 1.05	12.82 ± 1.02	0.33
PDW, %	14.75 ± 3.79	13.52 ± 2.48	0.32
Platelet count, 10^9/L	174.00 ± 78.88	213.56 ± 72.19	0.09
CRP, mg/L median (IQR)	47.00 [20.30, 200.50]	23.10 [9.00, 86.50]	0.08
BUN, mmol/L median (IQR)	5.89 [5.41, 7.89]	5.41 [4.74, 5.80]	0.02
Creatinine, umol/L median (IQR)	61.01 [50.01, 96.10]	61.02 [55.12, 74.75]	0.51
LCR median (IQR)	0.17 [0.03, 0.82]	0.70 [0.15, 2.60]	0.02
MLR	0.87 ± 0.56	0.50 ± 0.39	0.007
NLR median (IQR)	8.98 [4.86, 19.85]	4.22 [2.81, 7.75]	0.003
ALT, U/L	25.52 ± 9.80	22.13 ± 18.40	0.55
AST, U/L	23.53 ± 7.33	22.76 ± 17.32	0.89
Total bilirubin, umol/L	11.23 ± 5.25	11.55 ± 4.62	0.83
Prothrombin time, s	13.23 ± 1.95	13.09 ± 1.33	0.75
INR	1.12 ± 0.16	1.11 ± 0.11	0.79

Note: Renal insufficiency*: eGFR (30–60%).

Abbreviations: ALT, Alanine transaminase; AST, Aspartate aminotransferase; BUN, blood urine nitrogen; CAD, Coronary Artery Disease; CRP, Hypersensitive C-reactive protein; HbA1c, Hemoglobin A1c; HDL-C, high-density lipoprotein cholesterol; INR, International relations ratio; IQR, interquartile range; LCR, Lymphocyte to CRP ratio; LDL-C, low-density lipoprotein cholesterol; MLR, monocyte to lymphocyte ratio; NLR, neutrophil to lymphocyte ratio; PDW, platelet distribution width; RBC, red blood cell; RDW, red cell distribution width; WBC, white blood cell; TSH, Thyroid Stimulating Hormone.

Figure 1 LASSO coefficient profiles of the 12 factors. The horizontal axis represented the log(λ) value of the independent variable, the horizontal axis represented the number of variables with non-zero coefficient, the vertical axis represented the coefficient of the independent variable, and each curve represented the variation trajectory of the coefficient of each independent variable.

Figure 2 Ten-fold cross-validation for tuning parameter selection in the LASSO model. The dotted vertical lines were drawn at the best value of log(λ) by using the minimum criteria and 1-SE criteria. Solid vertical lines represented partial likelihood deviance ± SE. The intersection point of the left dotted line and the abscissa axis (bottom) showed the optimal value of log(λ), the corresponding value in the abscissa axis showed the number of variables with non-zero coefficient identified at the optimal log(λ).

Figure 3 (A) Nomogram to pridict outcome of wound healed; (B) Calibration curve.

Abbreviations: EH, Essential hypertension; G, Gram negative bacteria; NLR, Neutrophil to lymphocyte ratio; PLT, Platelet count.

Figure 4 Decision curve analysis.

Abbreviations: EH, Essential hypertension; G, Gram negative bacteria; NLR, Neutrophil to lymphocyte ratio; PLT, Platelet count.

Table 2 Multivariate Logistic Regression Analysis for Predictors of Healed Wound for Diabetes Foot Patients

Variables	p value	OR	95% CI
			Lower	Upper
Wagner grade	0.002	12.296	2.471	61.194
Essential hypertension	0.093	6.52	0.733	57.969
Neutrophil to lymphocyte ratio	0.443	1.048	0.93	1.18
Platelet count	0.018	0.978	0.961	0.996
Gram negative bacteria	0.058	0.113	0.012	1.081

Abbreviations: OR, odds ratio; CI, confidence interval.

Figure 5 Association between the PLT level and wound healed rate in T2DM patients, allowing for nonlinear effects, with 95% CIs. The RCS function with 3 knots for PLT level, adjusted for Wagner grade, was performed. Curves show ORs compared with the chosen reference PLT of 200*10^9/L.