Objective: Diabetic foot ulcer (DFU) is a common complication of diabetes mellitus, and it is also the main cause of infection, hospitalization, amputation and even death in patients with DFU. Neutrophil percentage-to-albumin ratio (NPAR) has been proved to be a predictor of death in many diseases. The aim of this study is to investigate the relationship between NPAR and mortality in patients with DFU.
Methods: This study included 1719 participants with DFU. The cutoff value of NPAR was determined according to the receiver operating characteristic (ROC) curve, and then the patients were divided into two groups: low NPAR group and high NPAR group. Cox proportional hazard regression was used to evaluate the association between NPAR and the risk of death in DFU patients. The difference in survival between groups was evaluated using Kaplan-Meier analysis and the log-rank test. Subgroup analyses were performed to determine whether there were differences in the effects of NPAR in different subgroups.
Results: The median age of all participants was 68 years old, and 61.1% of participants were males. By the end of follow-up, a total of 715 patients with DFU died. Patients with higher NPAR exhibited a significantly lower overall survival rate (P <0.001). The median survival in lower NPAR group is 119 months, compared to only 69 months in the high NPAR group. In multivariate Cox regression analysis, higher NPAR was an independent risk factor in patients with DFU compared with lower NPAR [adjusted hazard ratio (HR): 1.56; 95% confidence interval (CI): 1.29 - 1.89, P <0.001]. There was no statistically significant interaction between NPAR and any of the other DFU risk variables in the subgroup analysis. Conclusions NPAR is an independent predictor of the risk of mortality in patients with DFU. Higher NPAR is associated with increased mortality.
Keywords: Percentage of neutrophils; Albumin; Diabetic foot ulcer; Mortality
H. Zhu: None.
