Platelet-to-lymphocyte ratio (PLR), platelet-to-hemoglobin ratio (PHR) and systemic immune-inflammation index (SII) as predictive factors of amputation among Diabetic Foot Ulcer (DFU) in Ibnu Sina Gresik Regional Public Hospital, East Java, Indonesia

Introduction: Diabetic Foot Ulcer (DFU) is a common complication of Diabetic Mellitus, and predicting the result is a difficult task. In this context, the prediction of clinical outcomes such as amputation or wound healing manages further intervention of life-saving or limb-saving. Therefore, this research aimed to evaluate Platelet-to-Lymphocyte Ratio (PLR), Platelet-to-Hemoglobin Ratio (PHR), and Systemic Immune-inflammation Index (SII) as the predictive factors of amputation. Method: This retrospective analysis included hospitalized diabetic foot ulcer patients from January to December 2022 in Ibnu Sina Gresik Regional Public Hospital. Pre-treatment inflammatory markers, including the PLR, PHR, and SII, were performed by the Receiver Operating Characteristic (ROC) curve and Youden index to determine AUC and cut-off value, respectively. Results: This research comprised 58 amputated and 56 non-amputated patients. PLR, PHR and SII of amputation group showed a higher value significantly compared with the non-amputation group (p<0.001). Meanwhile, ROC analysis identified optimal cut-off values for PLR, PHR, and SII as 186.1, 3.09, and 2780.1 based on Youden index, respectively. PLR, PHR, and SII reported 74.1%,74.1%, and 44.8% sensitivity, with 92.9% (AUC = 0.878, p < 0.001), 82.1% (AUC = 0.834, p < 0.001), and 91.1% (AUC = 0.720, p < 0.001) specificity, respectively. Patients with higher PLR faced a 37.3-fold increased risk of amputation compared to those with lower scores (p < 0.001, 95% CI = 11.513-120.626). Higher PHR resulted in a 13.2-fold increased risk of amputation compared to lower scores (p < 0.001, 95% CI = 5.352-32.490), while higher SII obtained an 8.3-fold increased risk compared to lower scores (p < 0.001; 95% CI = 2.888-23.783). Conclusion: PLR, PHR and SII served as the predictive factors of amputation among diabetic foot ulcer patients.