Hemorheological disturbances as a marker of diabetic foot syndrome deterioration

Diabetes mellitus is associated with vascular abnormalities. Hemorheological variables as well as the transcutaneous oxygen pressure (TcPO2) were measured in 38 diabetic patients with critical limb ischemia to assess whether these variables could be of value to follow the deterioration in foot disease. Patients with previous history of foot ulcers or frank ulcers on presentation were followed for foot care. After a 12-month follow-up, they were divided into 2 subgroups based on the regression of foot disease: 30% of patients improved foot ischemia, i.e., healed or improved ulcer, while the remainder 70% deteriorated, i.e., impaired ulcer or underwent an amputation. RBC aggregation, plasma viscosity and fibrinogen level observed at baseline visit, were significantly higher in the patients who deteriorated. Blood viscosity values at both shear rates high and low were not significantly different between the 2 subgroups. TcPO2 was significantly lower in patients who deteriorated compared with those who improved. With regard to prognostic values, RBC aggregation parameters and fibrinogen level offered the highest positive predictive values (of 89%, 94%, and 88% respectively), comparable to that associated with TcPO2 (94%). Further analyses showed that combining markers of hemorheology with TcPO2 especially when TcPO2 value is in the range of 10-30 mmHg, may improve prognostic value for the management of the diabetic foot disease.