Associations of neutrophil-to-lymphocyte and platelet-to-lymphocyte ratios with amputation risk in patients with diabetic foot disease: a systematic review and meta-analysis
4 affiliations
- 1Department of Burn and Plastic Surgery, Ziyang Central Hospital, West China Hospital of Sichuan University-Ziyang Hospital, Ziyang, China
- 2Medical Affairs Department, Dazhou Central Hospital, Dazhou, China
- 3Department of Gastrointestinal and Anorectal Surgery, Sichuan Provincial People’s Hospital East Sichuan Hospital & Dazhou First People’s Hospital, Dazhou, China
- 4Dazhou Maternal and Child Health Hospital, Dazhou, Sichuan, China
Abstract
BackgroundNeutrophil-to-lymphocyte ratio (NLR) and platelet-to-lymphocyte ratio (PLR) are inexpensive inflammatory markers derived from routine blood counts. However, their value for assessing amputation risk in patients with diabetic foot ulcers (DFUs) remains uncertain. This meta-analysis aims to evaluate the associations and discriminatory performance of baseline NLR and PLR for DFU-related amputation.Material and methodsPubMed, Embase, the Cochrane Library, and Web of Science were searched from inception to July 2026 for English-language observational studies. Eligible studies reported baseline NLR or PLR according to amputation status or their area under the receiver operating characteristic curve (AUC) for amputation. Random-effects models were used to pool standardized mean differences (SMD) and AUC with 95% confidence intervals (CI). Risk of bias and certainty of evidence were assessed using the QUIPS tool and GRADE framework, respectively.ResultsThirteen studies involving 3,667 patients were included. Baseline NLR was higher in patients who underwent any amputation than in those managed with limb salvage (SMD 0.69, 95% CI 0.42–0.97; I2 = 85.5%) and showed moderate discriminatory performance (AUC 0.713, 95% CI 0.665–0.757; I2 = 0%). NLR was also higher in patients undergoing major amputation (SMD 0.97, 95% CI 0.18–1.77), whereas the minor-amputation comparison was not statistically significant (SMD 0.24, 95% CI −0.04 to 0.51). PLR was higher in patients undergoing any amputation (SMD 0.55, 95% CI 0.17–0.93) and showed a pooled AUC of 0.664 (95% CI 0.631–0.697; I2 = 0%). The certainty of evidence was moderate for both the associations of NLR and PLR with any amputation and their discriminatory performance assessed by AUC. Higher PLR was observed in the minor- and major-amputation groups, but both analyses were exploratory and included only two studies. Evidence certainty was moderate for minor amputation and low for major amputation.ConclusionsHigher baseline NLR and PLR were associated with DFU-related amputation, with more consistent evidence for NLR. These markers may complement clinical risk assessment but are insufficient for stand-alone decision-making. Prospective multicenter studies are needed to validate standardized thresholds and determine their added value within established classification systems.Systematic Review Registrationhttps://www.crd.york.ac.uk/PROSPERO/view/CRD420261461714, PROSPERO CRD420261461714.
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BibTeX
@article{liu2026associations,
title = {{Associations of neutrophil-to-lymphocyte and platelet-to-lymphocyte ratios with amputation risk in patients with diabetic foot disease: a systematic review and meta-analysis}},
author = {Yalan Liu and Dan Jiang and Aobo Zhu and Zhao Wang and Dengdeng Chen and Bin Zhao and Ximao Wang and Ximao Wang and Sheng Li},
journal = {Frontiers in Medicine},
year = {2026},
month = nov,
doi = {10.3389/fmed.2026.1950245},
url = {https://doi.org/10.3389/fmed.2026.1950245},
note = {CC BY},
}
RIS
TY - JOUR
TI - Associations of neutrophil-to-lymphocyte and platelet-to-lymphocyte ratios with amputation risk in patients with diabetic foot disease: a systematic review and meta-analysis
AU - Yalan Liu
AU - Dan Jiang
AU - Aobo Zhu
AU - Zhao Wang
AU - Dengdeng Chen
AU - Bin Zhao
AU - Ximao Wang
AU - Ximao Wang
AU - Sheng Li
PY - 2026
DA - 2026/11/06
JO - Frontiers in Medicine
DO - 10.3389/fmed.2026.1950245
UR - https://doi.org/10.3389/fmed.2026.1950245
AB - BackgroundNeutrophil-to-lymphocyte ratio (NLR) and platelet-to-lymphocyte ratio (PLR) are inexpensive inflammatory markers derived from routine blood counts. However, their value for assessing amputation risk in patients with diabetic foot ulcers (DFUs) remains uncertain. This meta-analysis aims to evaluate the associations and discriminatory performance of baseline NLR and PLR for DFU-related amputation.Material and methodsPubMed, Embase, the Cochrane Library, and Web of Science were searched from inception to July 2026 for English-language observational studies. Eligible studies reported baseline NLR or PLR according to amputation status or their area under the receiver operating characteristic curve (AUC) for amputation. Random-effects models were used to pool standardized mean differences (SMD) and AUC with 95% confidence intervals (CI). Risk of bias and certainty of evidence were assessed using the QUIPS tool and GRADE framework, respectively.ResultsThirteen studies involving 3,667 patients were included. Baseline NLR was higher in patients who underwent any amputation than in those managed with limb salvage (SMD 0.69, 95% CI 0.42–0.97; I2 = 85.5%) and showed moderate discriminatory performance (AUC 0.713, 95% CI 0.665–0.757; I2 = 0%). NLR was also higher in patients undergoing major amputation (SMD 0.97, 95% CI 0.18–1.77), whereas the minor-amputation comparison was not statistically significant (SMD 0.24, 95% CI −0.04 to 0.51). PLR was higher in patients undergoing any amputation (SMD 0.55, 95% CI 0.17–0.93) and showed a pooled AUC of 0.664 (95% CI 0.631–0.697; I2 = 0%). The certainty of evidence was moderate for both the associations of NLR and PLR with any amputation and their discriminatory performance assessed by AUC. Higher PLR was observed in the minor- and major-amputation groups, but both analyses were exploratory and included only two studies. Evidence certainty was moderate for minor amputation and low for major amputation.ConclusionsHigher baseline NLR and PLR were associated with DFU-related amputation, with more consistent evidence for NLR. These markers may complement clinical risk assessment but are insufficient for stand-alone decision-making. Prospective multicenter studies are needed to validate standardized thresholds and determine their added value within established classification systems.Systematic Review Registrationhttps://www.crd.york.ac.uk/PROSPERO/view/CRD420261461714, PROSPERO CRD420261461714.
SN - 2296-858X
ER -