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Predictive value of the ratio of homocysteine to serum albumin concentrations in the recurrence of diabetic foot ulcer

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International Journal of Diabetes in Developing Countries Aims and scope Submit manuscript

Abstract

Objective

To investigate the predictive value of the ratio of homocysteine to serum albumin concentrations (Hcy/Alb) in the recurrence of diabetic foot ulcer (DFU).

Methods

A total of 210 patients hospitalized due to diabetic foot disease from May 2012, to May 2017 were selected and followed up for one year. The value of Hcy/Alb in predicting the recurrence of DFU was determined using receiver operating characteristic (ROC) curve analysis.

Results

Hcy (odd ratio = 1.171; 95% confidence interval (CI) 1.101–1.246) was an independent risk factor for the recurrence of DFU. Alb (odd ratio = 0.848; 95% CI 0.792–0.908) was a protective factor for the recurrence of DFU. The area under the ROC curve of Hcy/Alb for predicting the recurrence of DFU was 0.803 (95% CI 0.742–0.864; p < 0.01). When the Hcy/Alb was set at the best cutoff value (0.37), its sensitivity in predicting the recurrence of DFU was 97.60%, and the negative predictive value was 98.93%.

Conclusions

The sensitivity and negative predictive value of Hcy/Alb in predicting the recurrence of DFU and the overall coincidence rate are high.

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References

  1. Boulton AJ. The diabetic foot: a global view. Diabetes Metab Res Rev. 2000;16:S2–5.

    Article  Google Scholar 

  2. Ribu L, Hanestad BR, Moum T, Birkeland K, Rustoen T. Health-related quality of life among patients with diabetes and foot ulcers: association with demographic and clinical characteristics. J Diabetes Complicat. 2007;21:227–36.

    Article  Google Scholar 

  3. Anichini R, Zecchini F, Cerretini I, Meucci G, Fusilli D, Alviggi L, et al. Improvement of diabetic foot care after the implementation of the international consensus on the diabetic foot (ICDF): results of a 5-year prospective study. Diabetes Res Clin Pract. 2007;75:153–8.

    Article  Google Scholar 

  4. Schaper NC, Van Netten JJ, Apelqvist J, Lipsky BA, Bakker K; International Working Group on the Diabetic Foot. Prevention and management of foot problems in diabetes: a summary guidance for daily practice 2015, based on the IWGDF guidance documents. Diabetes Metab Res Rev 2016;321:7–15.

  5. Singh N, Armstrong DG, Lipsky BA. Preventing foot ulcers in patients with diabetes. JAMA. 2005;293:217–28.

    Article  CAS  Google Scholar 

  6. Waaijman R, de Haart M, Arts ML, Wever D, Verlouw AJ, Nollet F, et al. Risk factors for plantar foot ulcer recurrence in neuropathic diabetic patients. Diabetes Care. 2014;37:1697–705.

    Article  Google Scholar 

  7. Winkley K, Stahl D, Chalder T, Edmonds ME, Ismail K. Risk factors associated with adverse outcomes in a population-based prospective cohort study of people with their first diabetic foot ulcer. J Diabet Complicat. 2007;21:341–9.

    Article  Google Scholar 

  8. Rankin TM, Miller JD, Gruessner AC, Nickerson DS. Illustration of cost saving implications of lower extremity nerve decompression to prevent recurrence of diabetic foot ulceration. J Diabetes Sci Technol. 2015;9:873–80.

    Article  Google Scholar 

  9. Škovierová H, Vidomanová E, Mahmood S, Sopková J, Drgová A, Červeňová T, et al. The molecular and cellular effect of homocysteine metabolism imbalance on human health. Int J Mol Sci. 2016;17:1733.

    Article  Google Scholar 

  10. Mao X, Xing X, Xu R, Gong Q, He Y, Li S, et al. Folic acid and vitamins D and B12 correlate with homocysteine in Chinese patients with type-2 diabetes mellitus, hypertension, or cardiovascular disease. Medicine (Baltimore). 2016;95:e2652.

    Article  CAS  Google Scholar 

  11. Alberti KG, Zimmet PZ. Definition, diagnosis and classification of diabetes mellitus and its complications. Part 1: diagnosis and classification of diabetes mellitus provisional report of a WHO consultation. Diabet Med. 1998;15:539–53.

    Article  CAS  Google Scholar 

  12. Boulton AJ. Foot problems in patients with diabetes mellitus. In: Pickup WG, editor. Texabook lf diabetes. 2th ed. London: Blackwell; 1997. p. 1.

    Google Scholar 

  13. Connor H, Mahdi OZ. Repetitive ulceration in neuropathic patients. Diabetes Metab Res Rev. 2004;20:S23–8.

    Article  Google Scholar 

  14. Jung S, Je Y, Giovannucci EL, Rosner B, Ogino S, Cho E. Derivation and validation of homocysteine score in U.S. men and women. J Nutr. 2015;145:96–104.

    Article  CAS  Google Scholar 

  15. Liu Z, Luo Y, Jeppesen PB, Gregersen S, Hermansen K. Amino acid-induced gene expression profiling in clonal β-cell line INS-1E cells. Diabetes Metab Res Rev. 2011;27:120–76.

    Article  Google Scholar 

  16. Weber GJ, Pushpakumar S, Tyagi SC, Sen U. Homocysteine and hydrogen sulfide in epigenetic, metabolic and microbiota related renovascular hypertension. Pharmacol Res. 2016;113:300–12.

    Article  CAS  Google Scholar 

  17. Srivastav K, Saxena S, Mahdi AA, Shukla RK, Meyer CH, Akduman L, et al. Increased serum level of homocysteine correlates with retinal nerve fiber layer thinning in diabetic retinopathy. Mol Vis. 2016;22:1352–60.

    CAS  PubMed  PubMed Central  Google Scholar 

  18. Satyanarayana A, Balakrishna N, Pitla S, Reddy PY, Mudili S, Lopamudra P, et al. Status of B-vitamins and homocysteine in diabetic retinopathy: association with vitamin-B12 deficiency and hyperhomocysteinemia. PLoS One. 2011;6:e26747.

    Article  CAS  Google Scholar 

  19. Mao S, Xiang W, Huang S, Zhang A. Association between homocysteine stats and the risk of nephropathy in type 2 diabetes mellitus. Clin Chim Acta. 2014;431:206–10.

    Article  CAS  Google Scholar 

  20. Gazzaruso C, Coppola A, Montalcini T, Baffero E, Garzaniti A, Pelissero G, et al. Lipoprotein(a) and homocysteine as genetic risk factors for vascular and neuropathic diabetic foot in type 2 diabetes mellitus. Endocrine. 2012;41:89–95.

    Article  CAS  Google Scholar 

  21. Jun JE, Lee SE, Lee YB, Jee JH, Bae JC, Jin SM, et al. Increase in serum albumin concentration is associated with prediabetes development and progression to overt diabetes independently of metabolic syndrome. PLoS One. 2017;12:e0176209.

    Article  Google Scholar 

  22. Vincent JL, Dubois MJ, Navickis RJ, Wilkes MM. Hypoalbuminemia in acute illness: is there a rationale for intervention? A meta-analysis of cohort studies and controlled trials. Ann Surg. 2003;237:319–34.

    PubMed  PubMed Central  Google Scholar 

  23. An JS, Zhao J, Wang XY. Risk factors of severe diabetic foot ulcer and amputations. Chin Gen Pract. 2017;11:37–44.

    Google Scholar 

  24. Yazdanpanah L, Nasiri M, Adarvishi S. Literature review on the management of diabetic foot ulcer. World J Diabetes. 2015;6:37–53.

    Article  Google Scholar 

  25. De Crée C, Malinow MR, van Kranenburg GP, Geurten PG, Longford NT, Keizer HA. Infuluence of exercise and menstrual cycle phase on plasma homocysteine levels in young women-a prospective study. Scand J Med Sci Sports. 1999;9:272–8.

    Article  Google Scholar 

  26. Samman S, Sivarajah G, Man JC, Ahmad ZI, Petocz P, Caterson ID. A mixed fruit and vegetable concent rate increases plasma antioxidant vitamins and folate and lowers plasma homocysteine in men. J Nutr. 2003;133:2188–93.

    Article  CAS  Google Scholar 

  27. Cotlarciuc I, Andrew T, Dew T, Clement G, Gill R, Surdulescu G, et al. The basis of differential responses to folic acid supplementation. J Nutrigenet Nutrigenomics. 2011;4:99–109.

    Article  CAS  Google Scholar 

  28. Markuson M, Hanson D, Anderson J, Langemo D, Hunter S, Thompson P, et al. The relationship between hemoglobin A1C values and healing time for lower extremity ulcers in individuals with diabetes. Adv Skin Wound Care. 2009;22:365–72.

    Article  Google Scholar 

  29. Feng SH, Wang PH, Zhu YJ. Patients with diabetic foot infection pathogenic bacteria distribution and drug resistance analysis. Chin J Diabetes. 2009;17:293–5.

    CAS  Google Scholar 

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Authors and Affiliations

  1. Department of Endocrinology, Jinzhou Central Hospital, Jinzhou, 121000, Liaoning Province, China

    Jingsi An, Xing Nie & Xueying Wang

  2. Department of Cardiology, Jinzhou Central Hospital, Jinzhou, 121000, Liaoning Province, China

    Hongwei Yu

  3. Subspeciality of Renal Hemodialysis, Jinzhou Central Hospital, Jinzhou, 121000, Liaoning Province, China

    Zhenyu Gao

  4. Central Laboratory, Jinzhou Central Hospital, Jinzhou, 121000, Liaoning Province, China

    Wei Yang

  5. Department of Endocrinology, Third Affiliated Hospital of Jinzhou Medical University, Jinzhou, 121000, Liaoning Province, China

    Jialin Li

  6. Eye Center, Jinzhou Central Hospital, Jinzhou, 121000, Liaoning Province, China

    Gang An

Authors
  1. Jingsi An
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  2. Hongwei Yu
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  3. Zhenyu Gao
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  4. Wei Yang
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  5. Jialin Li
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  6. Xing Nie
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  7. Xueying Wang
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  8. Gang An
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Corresponding authors

Correspondence to Jingsi An, Xueying Wang or Gang An.

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The authors declare that they have no conflict of interest.

Ethical approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee (Ethics Committee of Jinzhou Central Hospital, No. 2018-NFM-021) and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

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Informed consent was obtained from all individual participants included in the study.

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An, J., Yu, H., Gao, Z. et al. Predictive value of the ratio of homocysteine to serum albumin concentrations in the recurrence of diabetic foot ulcer. Int J Diabetes Dev Ctries 39, 667–672 (2019). https://doi.org/10.1007/s13410-019-00744-z

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  • DOI: https://doi.org/10.1007/s13410-019-00744-z

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