Inflammatory biomarkers and risk of re-amputation after transtibial or transfemoral amputation in diabetic patients
Journal of Foot and Ankle Surgery, cilt.65, sa.5, 2026 (SCI-Expanded, Scopus)
- Yayın Türü: Makale / Tam Makale
- Cilt numarası: 65 Sayı: 5
- Basım Tarihi: 2026
- Doi Numarası: 10.1053/j.jfas.2026.07.007
- Dergi Adı: Journal of Foot and Ankle Surgery
- Derginin Tarandığı İndeksler: Science Citation Index Expanded (SCI-EXPANDED), Scopus, CINAHL, EMBASE, MEDLINE
- Anahtar Kelimeler: Blood cell count, C-reactive protein, Complete blood count-derived indices, Diabetic foot, Inflammation, Level III, retrospective cohort study, Risk assessment
- İstanbul Üniversitesi-Cerrahpaşa Adresli: Evet
Özet
Background: Re-amputation after transtibial or transfemoral amputation may compromise healing and rehabilitation. Inflammatory markers may aid risk stratification. Purpose: To evaluate associations between preoperative inflammatory biomarkers, especially systemic immune-inflammation index (SII) and systemic inflammation response index (SIRI), and re-amputation risk. Study Design: Retrospective cohort study. Methods: We included 146 consecutive diabetic patients who underwent transtibial or transfemoral amputation for diabetic foot-related complications from January 2021 to December 2023. Patients with documented or imaging-confirmed peripheral arterial disease were excluded. Laboratory values within 48 hours before surgery were analyzed. Re-amputation was defined as additional bone resection at the same or a more proximal level. Patients without re-amputation were censored at death or last follow-up. Cox regression and receiver operating characteristic analyses were performed. Results: Re-amputation occurred in 26 patients (17.8%). Re-amputation was associated with higher white blood cell, neutrophil, monocyte, platelet, C-reactive protein (CRP), SII, SIRI, neutrophil-to-lymphocyte ratio, and platelet-to-lymphocyte ratio values. In exploratory multivariable Cox models adjusted for age and amputation level, SIRI (hazard ratio [HR], 1.048; 95% confidence interval [CI], 1.022–1.076; p < .001), SII per 1,000-unit increase (HR, 1.066; 95% CI, 1.011–1.123; p = .018), and CRP per 10 mg/L increase (HR, 1.094; 95% CI, 1.053–1.137; p < .001) remained associated with re-amputation. CRP had the highest area under the curve (0.762), followed by SII (0.746) and SIRI (0.740). Conclusions: Higher preoperative systemic inflammatory burden was associated with re-amputation. CRP performed best, while SII and SIRI showed moderate complementary value. External validation is required.