Beyond Inflammatory Ratios: Age and CRP as Key Predictors of Re-Amputation in Diabetic Foot Patients
6 affiliations
- 1Department of Orthopedics, Medicana International Hospital, 34520 Istanbul, Türkiye
- 2Department of Orthopedics, Nigde Omer Halisdemir University Research and Practice Hospital, 51100 Nigde, Türkiye
- 3Department of Orthopedics, Medical Point Hospital, 27584 Gaziantep, Türkiye
- 4Department of Internal Medicine, Gaziantep 25 Aralık State Hospital, 27090 Gaziantep, Türkiye
- 5Department of Orthopedics, Birecik State Hospital, 63400 Sanliurfa, Türkiye
- 6Department of Orthopedics, Gaziantep University Hospital, 27310 Gaziantep, Türkiye
Abstract
Background and Objectives: Re-amputation is an important adverse outcome of diabetic foot disease. This study compared age and preoperative inflammatory parameters between patients with and without subsequent re-amputation and examined their adjusted associations with re-amputation group membership. Materials and Methods: The records of 206 patients treated between 2013 and 2024 were reviewed retrospectively, with 103 patients included in each group. Laboratory parameters obtained before the index amputation were analyzed in both groups. Between-group comparisons were performed using the Mann–Whitney U test. Three exploratory binary logistic regression models included age and C-reactive protein (CRP), together with the neutrophil-to-lymphocyte ratio (NLR), monocyte-to-lymphocyte ratio (MLR), or platelet-to-lymphocyte ratio (PLR). The regression and ROC analyses were based on 197 complete cases. Results: Patients in the re-amputation group were older and had higher WBC, neutrophil, monocyte, CRP, NLR, MLR, and PLR values and lower lymphocyte values. In the primary model, age (adjusted OR = 1.034, 95% CI: 1.010–1.058; p = 0.006) and CRP (adjusted OR = 1.006 per 1 mg/L, 95% CI: 1.003–1.010; p = 0.001) were independently associated with re-amputation group membership, whereas NLR was not (p = 0.834). Neither MLR (p = 0.176) nor PLR (p = 0.446) was independently associated in the alternative models. Individual-marker AUCs ranged from 0.604 to 0.647, indicating limited discrimination. Conclusions: Older age and higher pre-index-amputation CRP levels were independently associated with membership in the re-amputation group. Although NLR, MLR, and PLR differed between groups, these ratios were not independently associated after adjustment for age and CRP. The limited discriminatory performance and data-derived cutoff values require validation in larger, independent cohorts.
Related
- Predictive Value of Preoperative Inflammatory and Nutritional Indices for Revision Surgery After Major Lower Extremity Amputation in Patients With Wagner Stage 5 Diabetic Foot.
- Plasma albumin and the risk of amputation and mortality in patients hospitalised with diabetic foot ulcers: a Danish nationwide register-based cohort study
- Association between thyroid feedback quantile-based index and the risk of in-hospital amputation in patients with diabetic foot ulcer.
- 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
- Prognostic Value of the Pan-Immune Inflammatory Value and Fibrinogen-To-Albumin Ratio for Amputation in Patients With Lower Extremity Arterial Disease
BibTeX
@article{gokcen2026beyond,
title = {{Beyond Inflammatory Ratios: Age and CRP as Key Predictors of Re-Amputation in Diabetic Foot Patients}},
author = {Huseyin Bahadir Gokcen and Alp Yekta Gokalp and Sezgin Bahadir Tekin and Gizem Tekin and Onur Mercan and Umut Kahilogullari},
journal = {Metabolites},
year = {2026},
month = oct,
doi = {10.3390/metabo16100778},
url = {https://www.mdpi.com/2218-1989/16/10/778},
note = {CC BY 4.0},
}
RIS
TY - JOUR
TI - Beyond Inflammatory Ratios: Age and CRP as Key Predictors of Re-Amputation in Diabetic Foot Patients
AU - Huseyin Bahadir Gokcen
AU - Alp Yekta Gokalp
AU - Sezgin Bahadir Tekin
AU - Gizem Tekin
AU - Onur Mercan
AU - Umut Kahilogullari
PY - 2026
DA - 2026/10/14
JO - Metabolites
DO - 10.3390/metabo16100778
UR - https://www.mdpi.com/2218-1989/16/10/778
AB - Background and Objectives: Re-amputation is an important adverse outcome of diabetic foot disease. This study compared age and preoperative inflammatory parameters between patients with and without subsequent re-amputation and examined their adjusted associations with re-amputation group membership. Materials and Methods: The records of 206 patients treated between 2013 and 2024 were reviewed retrospectively, with 103 patients included in each group. Laboratory parameters obtained before the index amputation were analyzed in both groups. Between-group comparisons were performed using the Mann–Whitney U test. Three exploratory binary logistic regression models included age and C-reactive protein (CRP), together with the neutrophil-to-lymphocyte ratio (NLR), monocyte-to-lymphocyte ratio (MLR), or platelet-to-lymphocyte ratio (PLR). The regression and ROC analyses were based on 197 complete cases. Results: Patients in the re-amputation group were older and had higher WBC, neutrophil, monocyte, CRP, NLR, MLR, and PLR values and lower lymphocyte values. In the primary model, age (adjusted OR = 1.034, 95% CI: 1.010–1.058; p = 0.006) and CRP (adjusted OR = 1.006 per 1 mg/L, 95% CI: 1.003–1.010; p = 0.001) were independently associated with re-amputation group membership, whereas NLR was not (p = 0.834). Neither MLR (p = 0.176) nor PLR (p = 0.446) was independently associated in the alternative models. Individual-marker AUCs ranged from 0.604 to 0.647, indicating limited discrimination. Conclusions: Older age and higher pre-index-amputation CRP levels were independently associated with membership in the re-amputation group. Although NLR, MLR, and PLR differed between groups, these ratios were not independently associated after adjustment for age and CRP. The limited discriminatory performance and data-derived cutoff values require validation in larger, independent cohorts.
SN - 2218-1989
ER -