Association between monocyte to lymphocyte ratio and diabetic foot ulcer in the population of the US with diabetes based on the 1999-2004 National Health and Nutrition Examination Survey data: a retrospective cross-sectional study

Front Endocrinol (Lausanne). 2024 Apr 24:15:1361393. doi: 10.3389/fendo.2024.1361393. eCollection 2024.

Abstract

Background: Diabetic foot ulcer (DFU) is a severe complication that occurs in patients with diabetes and is a primary factor that necessitates amputation. Therefore, the occurrence and progression of DFU must be predicted at an early stage to improve patient prognosis and outcomes. In this regard, emerging evidence suggests that inflammation-related markers play a significant role in DFU. One such potential marker, the monocyte-lymphocyte ratio (MLR), has not been extensively studied in relation to DFU. This study aimed to define a connection between MLR and DFU.

Methods: A cross-sectional study was conducted using National Health and Nutrition Examination Survey (NHANES) data from 1999 to 2004. DFU was defined based on survey questionnaires assessing the presence of nonhealing ulcers in the lower extremities for more than 4 weeks in diabetes patients. The MLR was calculated as the ratio of the monocyte count to the lymphocyte count, which was directly obtained from laboratory data files. Logistic regression analysis was performed to assess the relationship between the MLR and DFU. Stratified analysis according to age, sex, body mass index, blood glucose, hemoglobin, and glycated hemoglobin categories was conducted, and multiple imputations were applied to missing data.

Results: In total, 1246 participants were included; the prevalence of DFU was 9.4% (117/1246). A multivariable regression model revealed a significant association between DFU and a 0.1 unit increase in MLR after adjusting for all covariates (adjusted odds ratio=1.16, 95% confidence interval: 1.02-1.33). Subgroup analyses revealed consistent findings regarding the impact of MLR on the presence of DFU (p > 0.05).

Conclusion: MLR is significantly associated with DFU in diabetes patients, and can be used as one of the indicators for predicting the occurrence of DFU. MLR assessment may be a valuable component in the follow-up of patients with diabetes.

Keywords: diabetic foot ulcer; NHANES; diabetes; inflammation; monocyte-lymphocyte ratio.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adult
  • Aged
  • Biomarkers / blood
  • Cross-Sectional Studies
  • Diabetic Foot* / blood
  • Diabetic Foot* / epidemiology
  • Female
  • Humans
  • Lymphocyte Count
  • Lymphocytes*
  • Male
  • Middle Aged
  • Monocytes*
  • Nutrition Surveys*
  • Prognosis
  • Retrospective Studies
  • United States / epidemiology

Substances

  • Biomarkers

Grants and funding

The author(s) declare that financial support was received for the research, authorship, and/or publication of this article. This work was supported by the Collaborative Innovation Center of Chinese Ministry of Education (2020-39); and the Scientific and Technological Innovation Talent Team of Wound Surgery Integrated Treatment of Guizhou Province (Talents Science Cooperation Platform of Guizhou, No. 2020-5012); and the Constructive Project of Innovative Talent Platform Carrier for Precise Repair of Wounds (Talents Science Platform of Zunyi city, No. 2021-3); and the Scientific Research and Talent Training Funds of Kweichow Moutai Hospital (MTYK, No.2022-13).