The Relationship Between Plasma Fibrinogen Levels and the Severity of Diabetic Foot Ulcers in Diabetic Patients.

Abstract

Background Diabetic foot ulcers (DFUs) are a common and debilitating complication of diabetes mellitus, often leading to hospitalization, amputation, and reduced quality of life. Monitoring biomarkers that reflect inflammatory processes can be crucial for assessing DFU severity and guiding treatment. This study explores the relationship between plasma fibrinogen levels and DFU severity, along with its association with various clinical and inflammatory biomarkers. Objective To assess the relationship between plasma fibrinogen levels and DFU severity, vascular health, infection risk, and other biomarkers in diabetic patients, with the aim of improving the prediction and management of DFU outcomes. Methods A cross-sectional, observational study was conducted at Mardan Medical Complex from June 2024 to January 2025, involving 93 diabetic patients with active DFUs. The severity of DFUs was classified using the Wagner system, and vascular health was assessed using the Ankle-Brachial Index (ABI) and Doppler ultrasound. Plasma fibrinogen levels, along with other biomarkers such as C-reactive protein (CRP), erythrocyte sedimentation rate (ESR), and fasting blood glucose, were measured through fasting blood samples. Data analysis included statistical tests such as Kruskal-Wallis, Mann-Whitney, ANOVA, Decision Trees, Box Plots, Violin Plot, Histograms, and Regression models to explore the associations between fibrinogen levels and DFU severity, vascular impairment, and inflammatory markers. Significance was set at p < 0.05. Results The study examined 93 diabetic patients (mean age: 59.02 ± 7.86 years), comprising 49 males (52.68%) and 44 females (46.32%). Among the participants, 28 (30.11%) presented with severe ulcers (Wagner Grade 5), and 53 (56.99%) exhibited critical ischemia. Bacterial infections were identified in 71 (76.34%) of the patients. The mean plasma fibrinogen level was significantly elevated at 681 ± 160 mg/dL, surpassing the normal range. Plasma fibrinogen levels increased with ulcer severity, with medians of 503.51 mg/dL for Wagner Grade 2, 623.45 mg/dL for grade 3, 627.32 mg/dL for grade 4, and 720.77 mg/dL for grade 5 ulcers. Higher fibrinogen levels were also associated with greater ulcer depth (p = 0.046). Additionally, vascular impairment was significantly correlated with fibrinogen levels, with non-palpable pedal pulses and severe peripheral arterial disease showing associations with elevated fibrinogen levels (p = 0.0083 and p = 0.0478, respectively). Furthermore, fibrinogen levels were positively correlated with CRP (r = 0.50) and with comorbidities such as hypertension in 66 (70.97%) patients and chronic kidney disease in 20 (21.51%) patients. Conclusion Plasma fibrinogen levels are strongly associated with DFU severity and could serve as an effective biomarker for predicting disease progression. Monitoring fibrinogen, along with other biomarkers, may help clinicians stratify patients based on their risk of complications and guide more targeted treatment strategies.