MHR and CRP/Albumin Ratio Correlate with Wagner Grade in Diabetic Foot Ulcers: A Chinese Retrospective Study with...

Assessing the severity of diabetic foot ulcers (DFU) is critical for prognosis and treatment. While the Wagner classification is widely used, it lacks systemic inflammatory and nutritional assessment. Composite markers like the monocyte-to-high-density lipoprotein cholesterol ratio (MHR) and C-reactive protein-to-albumin ratio (CAR) may fill this gap. Furthermore, regional data on pathogen distribution in China are essential for guiding antibiotic therapy.

To investigate the correlation of MHR and CAR with Wagner grades in Chinese DFU patients, identify independent predictors for severity, and analyze pathogen distribution and drug resistance patterns across different grades.

A retrospective analysis was conducted on 136 DFU patients hospitalized from January 2022 to May 2024. Patients were categorized into three groups based on Wagner grades: Grade 1-2 (n=17), Grade 3 (n=42), and Grade 4-5 (n=77). Clinical data, MHR, and CAR were analyzed. Spearman correlation and ordinal logistic regression determined associations with severity. Receiver operating characteristic (ROC) curves evaluated the predictive value of MHR and CAR for severe infection (Wagner 4-5). Pathogen profiles were analyzed per group.

MHR (r=0.451, P<0.001) and CAR (r=0.521, P<0.001) were significantly and positively correlated with Wagner grades. Logistic regression identified serum albumin (OR=0.88, 95% CI: 0.82-0.95, P=0.002) and HDL-C (OR=0.11, 95% CI: 0.02-0.68, P=0.017) as independent protective factors against higher Wagner grades. For predicting severe infection, the optimal cut-off values were 0.775 for MHR (AUC=0.760) and 2.04 for CAR (AUC=0.777). Among 183 isolated strains, Staphylococcus aureus (24.59%) was predominant. Notably, as Wagner grades increased, the prevalence of Gram-negative bacteria (e.g. Escherichia coli, Pseudomonas aeruginosa) and mixed infections rose significantly (P<0.01).

MHR and CAR are valuable biological markers for assessing DFU severity in the Chinese population. Albumin and HDL-C serve as independent protective factors. The study reveals a grade-dependent shift in pathogen spectra toward Gram-negative bacteria and mixed infections, providing region-specific evidence for optimizing empirical antibiotic strategies.