The Association of Wagner Classification, Microbial Resistance, Immune Markers, and Glycemic Control With Diabetic...

Leukocytes play a crucial role in immune function, and inflammatory markers such as neutrophil-to-lymphocyte ratio (NLR), platelet-to-lymphocyte ratio (PLR), and monocyte-to-lymphocyte ratio (MLR) are emerging as important predictors of diabetic foot ulcer (DFU) severity, infection risk, and healing outcomes. These markers may aid in early detection and improved prognosis. This study aims to evaluate the predictive value of inflammatory markers (NLR, PLR, MLR, total leukocyte count (TLC), absolute lymphocyte count (ALC)) in relation to DFU severity, glycemic control, and healing outcomes.

A comparative cross-sectional study was conducted at the endocrinology Ward of Hayatabad Medical Complex (HMC), Peshawar. A total of 102 diabetic foot ulcer patients were included in the study. Patients' consent, demographic data, and clinical data were taken. Blood samples were collected for hematological, biochemical analysis, and wound culture samples for bacterial species identification and drug sensitivity. Data was collected and analyzed through SPSS 22 (IBM Corp., Armonk, NY, USA).

A weak negative correlation was observed between ALC and Wagner grade (ρ = -0.134), which was not statistically significant. TLC also demonstrated a weak negative correlation with Wagner grade (ρ = -0.240), approaching but not reaching statistical significance. A weak positive correlation was found between TLC and hemoglobin A1C (HbA1C) (ρ = 0.199), which was statistically significant. In contrast, ALC showed no significant correlation with either HbA1c (ρ = -0.002) or fasting blood sugar (FBS) (ρ = -0.066). Statistically significant reductions were observed in FBS (p < 0.001), random blood sugar (p < 0.001), and TLC (p < 0.001) following treatment. Microbiological analysis of diabetic foot ulcers revealed a diverse range of bacterial isolates. The most frequently identified organism was Pseudomonas aeruginosa (13, 12.7%), followed by Escherichia coli (12, 11.8%) and Proteus species (11, 10.8%).

No significant association was observed between ALC and Wagner grade in this study. Further studies with larger sample sizes are needed to clarify this relationship. However, a positive correlation between TLC and glycemic control suggests that poor glycemic control can affect the immune system and decrease the healing process, which may result in increased hospital stays for patients or unhealed ulcers leading to amputation.