The international journal of lower extremity wounds最新文献

{"title":"Association Between red Cell Distribution Width/Albumin Ratio and Diabetic Lower Extremity Ulcers (DLEU) among US Outpatients in the NHANES: A Retrospective Cross-Sectional Study.","authors":"Dali Huang, Kang Wang, Ting Deng, Ting Yang, Jinmin Cao","doi":"10.1177/15347346241273156","DOIUrl":"10.1177/15347346241273156","url":null,"abstract":"<p><p>ObjectiveDiabetic foot ulcers are common chronic complications of diabetes mellitus that can lead to amputation and death in severe cases. There is limited research on the relationship between the red cell distribution width/albumin ratio and diabetic lower-extremity ulcers. The few studies that have been conducted have been in single-center inpatient settings and there is limited research in outpatient settings. This study investigated this relationship in adult outpatient clinics in the United States.MethodsA retrospective cross-sectional study was conducted with 1624 participants of the National Health and Nutrition Examination Survey (NHANES) from 1999 to 2004. Three logistic regression models were developed to assess the association between red cell distribution width/albumin ratio and diabetic lower-extremity ulcers. The ratio was analyzed as a continuous and categorical variable. Stratified analyses were performed based on age, sex, HbA1c level, and body mass index.ResultsThe study included 1624 adults, with a mean age of 65.0 ± 12.0 years, of whom 58.8% were male. The prevalence of diabetic lower-extremity ulcers was 8.0% (<i>n</i> = 131). Compared with individuals with a lower red cell distribution width/albumin ratio in T1(2.32,2.93), the adjusted OR values for the ratio and ulcers in T2(2.94,3.26), T3(3.27,7.42), and 2.07 (95% CI = 1.19∼3.61), 2.92 (95% CI = 1.63∼5.23). The association between the ratio and ulcers exhibited a non-linear relationship (nonlinear, <i>P</i> = .028).ConclusionThese results support the hypothesis of an S-shaped relationship between red cell distribution width/albumin and diabetic lower-extremity ulcers. Monitoring the RDW/Albumin ratio could be crucial for preventing diabetic lower-extremity ulcers in outpatient settings. Regular assessments may help identify high-risk patients early, enabling timely interventions. Future studies should further assess these two factors and their underlying mechanisms.</p>","PeriodicalId":94229,"journal":{"name":"The international journal of lower extremity wounds","volume":" ","pages":"752-761"},"PeriodicalIF":1.5,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141904103","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Global Hotspots and Trends of Diabetic Foot Ulcer Therapy: A Bibliometric Analysis from 2004 and 2023.","authors":"Yungang Hu, Yaling Zhao, Huimin Wu, Xiaolin Li, Qi Zeng","doi":"10.1177/15347346241311065","DOIUrl":"10.1177/15347346241311065","url":null,"abstract":"<p><p>Diabetic foot ulcer (DFU) is a common complication of diabetes, associated with increased rates of amputation and mortality. In recent years, great progress has been made in the treatment of DFU, but there is still a lack of bibliometric research on the treatment of DFU.DFU therapy publications published between 1 January 2004 and 31 December 2023 were retrieved from the Web of Science Core Collection (WoSCC) database for analysis using VOSviewer and CiteSpace analytics. A total of 4833 publications on DFU from 2004 to 2023 were included in the WoSCC database. The United States had the highest productivity with 1463 papers, accounting for 30.27% of the total production, followed by China with 907 papers (18.77%) and England with 438 papers (9.06%). In terms of research institutions and journals, the University of Texas System and Journal of Wound Care published the highest number of papers. High-frequency keywords in the field of DFU therapy mainly concentrated on management, wound healing, and amputation. This study conducted a systematic bibliometric analysis of DFU therapy publications from 2004 and 2023. Improving DFU management, promoting wound healing, and reducing amputation rates are the hotspots and future trends in this field. Our work provides valuable insights into the research trajectory and future avenues of exploration in the field of DFU therapy. These findings provide strong support for academic research and clinical practice.</p>","PeriodicalId":94229,"journal":{"name":"The international journal of lower extremity wounds","volume":" ","pages":"878-890"},"PeriodicalIF":1.5,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142960882","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Nanotechnological Advances in Burn Wound Care: Silver Sulfadiazine-Loaded Nanosuspension-Based Chitosan-Incorporated Nanogel for Partial Thickness Burns.","authors":"Harshita Barkat, Md Abul Barkat, Raisuddin Ali, Hazrina Hadi","doi":"10.1177/15347346241309425","DOIUrl":"10.1177/15347346241309425","url":null,"abstract":"<p><p>Burn lesions damage the skin's outermost defensive layer, allowing pathogenic microbes including <i>Pseudomonas aeruginosa, Staphylococcus aureus and Escherichia coli</i> to infiltrate. Silver sulfadiazine (SSD) is an effective antibacterial agent approved by U.S. Food and Drug Administration (US-FDA) and is considered as the gold standard for burn wound treatment. Despite the high degree of efficacy of SSD in burn wound management, it possesses some drawbacks, such as poor solubility, low topical bioavailability and skin irritations. The present study endeavors to develop nanosuspension based SSD nanogel for improving the deliverability of SSD and its therapeutic outcomes for the management of partial thickness burn. The SSD nanosuspension was formulated employing controlled nanoprecipitation approach using various surfactants. The formulation was optimized utilizing one-factor-at-a-time approach and to fetch the optimized formulation of 134.6 nm size. The optimized nanosuspension was incorporated into chitosan gel that offer superior drug release potential, and also offered better spreadability (5.21 ± 0.38 g) and extrudability (152.27 ± 0.22 gm) that represents the easy application over the skin and extrusion of gel from the tube. The formulation was well tolerated as shown by skin irritation study and offered a superior burn lesion healing characteristics vis-à-vis the marketed product, even at a lower concentration. Hence, the formulation offers a huge potential in enhancing the clinical outcomes of SSD, especially in the management of partial thickness burn. The developed system with the above mentioned outcomes could be a promising delivery system for partial thickness burn wound management.</p>","PeriodicalId":94229,"journal":{"name":"The international journal of lower extremity wounds","volume":" ","pages":"916-928"},"PeriodicalIF":1.5,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143019153","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"A Network Meta-Analysis of Randomized Controlled Trials on the Comparative Efficacy of Stem Cells Therapy for Diabetic Foot Ulcer Healing.","authors":"Shiv Kumar Mudgal, Subodh Kumar, Suresh K Sharma, Rakhi Gaur, Dibyajyoti Saikia, Harminder Singh, Saurabh Varshney, Ashoo Grover, Seshadri Reddy Varikasuvu","doi":"10.1177/15347346241286216","DOIUrl":"10.1177/15347346241286216","url":null,"abstract":"<p><p>Stem cell therapy in diabetic foot ulcer has emerged as a promising treatment option to promote ulcer healing. This network meta-analysis was undertaken to evaluate how they compete with each other and their ranking with respect to chances of ulcer healing. A systematic search strategy to retrieve data from five databases, were used to identify potential studies. Randomized controlled trial or clinical controlled trial, published in English, using any type of stem cells as intervention in individuals aged over 18 years diagnosed with diabetic foot ulcers were included. This network meta-analysis was performed using frequentist method using R version 4.2.1. Eighteen clinical trials were included in the study which included 13 interventions. The study found that most of the stem cells were significantly promoting ulcer healing chances with human viable wound matrix (hVWM) [RR 2.91; CI: 1.28, 6.64], peripheral blood mononuclear cells (PBMNC) [RR 2.35; CI: 1.21, 4.55], bone marrow mesenchymal stem cells (BMMSCs) [RR 2.20; CI: 1.34, 3.60], were top three stem cell options among all. P score also suggested the same. Risk of bias study suggested that there was \"some concern or \"high risk'' among majority of studies. It is evident from this study that bone marrow mononuclear cells were found to be most effective in wound healing in cases of diabetic foot ulcer in that order. Though there was no significant difference between these and more studies were required to ascertain whether they differ in term of efficacy for the clinical outcome of ulcer healing.</p>","PeriodicalId":94229,"journal":{"name":"The international journal of lower extremity wounds","volume":" ","pages":"788-799"},"PeriodicalIF":1.5,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142305245","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Red Leg Dilemma: Development and Validation of Clinical Decision Tools for Non-Necrotizing Bacterial Dermohypodermitis, Necrotizing Fasciitis, and Eczematous Dermatitis.","authors":"Charbel Skayem, Thulan Charras, Viet-Thi Tran, Camille Hua, Giao Do Pham, Gaëlle Hirsch, Ouidad Zehou, Tu Anh Duong","doi":"10.1177/15347346241290408","DOIUrl":"10.1177/15347346241290408","url":null,"abstract":"<p><p>BackgroundDiagnosing red legs on first presentation is challenging. There exists a lack of robustly developed and validated diagnostic red leg tools in clinical practice. Physicians fear missing cases of infectious red legs and treat many patients unnecessarily with antibiotics.ObjectiveDevelop and validate easy-to-use diagnostic tools applicable at bedside of patients to orient diagnosis of the commonest and most serious causes of infectious red legs (non-necrotizing bacterial dermohypodermitis (NNBDH), and necrotizing fasciitis (NF)) versus the commonest inflammatory cause (eczema).MethodsWe collected data of patients presenting to our dermatology department from January first 2012 until May 17th 2017 with a diagnosis of red leg. Three models were developed using fast frugal trees. Validation was performed in a second cohort of patients.ResultsA total of 187 patients (mean age 56, SD = 21 years, 48.1% women) were included in the development phase and 62 patients (mean age 64, SD = 19, 52% women) in the validation phase. In the validation data set, sensitivity and specificity were respectively 67% and 91% for NNBDH, 83% and 66%, for NF and 88% and 93%, for eczema.ConclusionPresentations of suspected lower-limb infections are commonly misdiagnosed, resulting in avoidable antibiotic prescription and hospitalization. We developed an easy-to-use clinical diagnostic tool applicable at the bedside of patients to help orient physicians in certain situations and avoid unnecessary initiation of antibiotics. Future work should focus on validating this tool in primary care to minimize misdiagnosis of red legs and overprescription of antibiotics.</p>","PeriodicalId":94229,"journal":{"name":"The international journal of lower extremity wounds","volume":" ","pages":"1052-1058"},"PeriodicalIF":1.5,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142669820","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Efficacy of Topical Timolol in Chronic Unhealed Ulcers: A Systematic Review and Meta-Analysis.","authors":"Muhammad M Elsharkawy, Eslam Mohammed Rabea, Anas Ashraf Elassal, Anan Maher Salaimeh, Adam Naji Zaro, Saad Mohamed Saad, Mohamed Eldesouki","doi":"10.1177/15347346251345249","DOIUrl":"10.1177/15347346251345249","url":null,"abstract":"<p><p>BackgroundTopical timolol appears to provide a curative effect in managing chronic ulcers. However, the pooled evidence of its effect hasn't been established yet. This is the first Meta-analysis to evaluate and assess the efficacy of topical timolol in accelerating wound healing in patients with chronic refractory ulcers.MethodsWe comprehensively searched different electronic databases; PubMed, Scopus, Web of Science, Cochrane library and ClinicalTrials.gov from their inception to November 2024. The search was conducted without imposing any restrictions on publication date or study design. The ROB-II tool was used to assess the quality of included RCTs. NIH tools were used to evaluate the quality of included cohort and single arm studies. Risk ratios (RR) and mean differences (MD), with 95% confidence intervals (CIs), were used as effect estimates.ResultsSix studies were included in this systematic review, comprising two single-arm studies and four double-arm studies (3 RCTs and 1 cohort study). Data from the four double-arm studies on venous ulcers were pooled for meta-analysis. The results showed that topical timolol significantly reduced ulcer area compared to control at 2 weeks (-23.63%; 95% CI: -29.26 to -18.00; p < 0.00001), 4 weeks (-41.40%; 95% CI: -49.57 to -33.23; p < 0.00001), and 12 weeks (-23.38%; 95% CI: -39.43 to -7.33; p = 0.004). Complete ulcer healing was observed at 4 weeks (RR: 12.00; 95% CI: 1.68 to 85.84; p = 0.01) and 12 weeks (RR: 3.79; 95% CI: 0.44 to 32.54; p = 0.22).ConclusionTopical timolol has the potential to promote healing in chronic unhealed ulcers. This meta-analysis, focusing on chronic venous ulcers, consistently showed favorable results across different time points. However, the small sample sizes, lack of blinding, and inclusion of only four studies limit the generalizability of the findings.</p>","PeriodicalId":94229,"journal":{"name":"The international journal of lower extremity wounds","volume":" ","pages":"675-686"},"PeriodicalIF":1.5,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144129802","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The Effectiveness of Diabetic Foot Wound Prevention Training Given with Pecha Kucha (20*20) Presentation Technique: A Randomized Controlled.","authors":"Berna Dincer, Ceren Kocali, Tuba Elveren, Serdar Demir, Kemal Demir, Fatoş Nimet Dolu, Güneş Feyizoğlu","doi":"10.1177/15347346251318778","DOIUrl":"10.1177/15347346251318778","url":null,"abstract":"<p><p>This study aimed to evaluate the impact of diabetic foot care training delivered using the Pecha Kucha (20*20) presentation method on the knowledge, self-efficacy, and behavior levels of patients with Type 2 diabetes. Conducted between December 10, 2023, and October 7, 2024, this randomized controlled experimental study included 125 diabetic individuals, with 62 in the experimental group and 63 in the control group. The experimental group received diabetic foot care education using the Pecha Kucha method, while the control group received conventional education. Data were collected using the Patient Assessment Form, Diabetes Foot Knowledge Questionnaire, Diabetic Foot Care Self-Efficacy Scale, and Foot Self-Care Behavior Scale. Statistical analyses revealed that the experimental group demonstrated significantly higher scores in knowledge and self-efficacy compared to the control group (p < 0.001), while no significant difference was found in self-care behavior scores (p > 0.05). The results suggest that the Pecha Kucha method effectively enhances diabetic individuals' knowledge and self-efficacy regarding foot care. However, further research is needed to explore its long-term impact on behavior changes. The study was registered in Clinical Trials (https://clinicaltrials.gov/study/NCT06768645) with the registration number of \"NCT06768645\".</p>","PeriodicalId":94229,"journal":{"name":"The international journal of lower extremity wounds","volume":" ","pages":"960-970"},"PeriodicalIF":1.5,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143412236","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The Infected Diabetic Foot: Does Negative Pressure Wound Therapy with Irrigation Reduce Bioburden and Improve Wound Healing?","authors":"Mehmet A Suludere, Matthew Malone, Michael C Siah, Arthur Tarricone, Tyler L Coye, Bijan Najafi, Lawrence A Lavery","doi":"10.1177/15347346241292125","DOIUrl":"10.1177/15347346241292125","url":null,"abstract":"<p><p>The aim of this study was to compare the microbial loads of patients with diabetic foot infections treated with negative pressure wound therapy (NPWT) with and without irrigation with polyhexamethylene biguanide (NPWTi-P). This is a post hoc analysis of combined data of two randomized clinical trials. We evaluated people with diabetes treated with moderate and severe diabetic foot infections that required surgery. Tissue specimens were obtained after the initial surgery and following a second planned return to the operating room after 48-72 h of NPWT or NPWTi-P, prior to the second surgery. We used quantitative polymerase chain reaction (qPCR) to determine the total microbial loads (Log₁₀ 16S copies per gram of tissue). There was no difference in mean quantitative bacterial cultures among patients that received NPWT and NPWTi-P (before first surgery Log₁₀: NPWT = 6.4 ± 1.8, NPWTi-P = 7.5 ± 1.7 vs before second surgery Log₁₀: NPWT = 6.7 ± 1.8, NPWTi-P = 7.6 ± 1.9 p = .12). There was no difference in wound healing (59.5% vs 50.0%, p = .51) or time to heal (127 ± 109.3 vs 143 ± 95.9), p = .71). There were fewer re-infections in people that received traditional NPWT (28.6% vs 56.3%, p = .05).<b>Level of Clinical Evidence:</b> Level 1.</p>","PeriodicalId":94229,"journal":{"name":"The international journal of lower extremity wounds","volume":" ","pages":"1044-1051"},"PeriodicalIF":1.5,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13438004/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142635465","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"A Double-Blind Study on the Effectiveness of Polarized Light Therapy in the Treatment of Venous leg Ulcers-Pilot Study.","authors":"Jarosław Pasek, Sebastian Szajkowski, Grzegorz Cieślar","doi":"10.1177/15347346241264602","DOIUrl":"10.1177/15347346241264602","url":null,"abstract":"<p><p>Vein diseases are one of the most common civilization diseases. The most advanced form chronic venous insufficiency are venous leg ulcers. The study included 40 patients, 20 male (50%) and 20 female (50%) in age between 52 and 88 years (mean age: 68.00 ± 8.55 years) with venous leg ulcers lasting 12.50 ± 5.45 months. Patients were distributed randomly in a double-blind study into two equal groups including 20 patients each (group 1-polarized light therapy and group 2-sham exposure). Patients from both groups received routine pharmacological treatment, specialistic medical dressings and compression therapy. In addition, patients were exposed to a cycle of polarized light therapy procedures or to sham exposures (30 procedures performed in two series of 15 procedures). Wound surface area was evaluated by computerized planimetry and pain intensity was assessed with the use of Visual Analog Scale (VAS) before and after therapy (2.5 months). The analysis showed a statistically significant reduction of surface ulcers area between groups 1 and 2. The median (IQR) size of wounds in group 1 was 2.4 (1.95-2.9) cm², in group 2; 2.8 (2.6-3.1) cm² (<i>p</i> = 0.038). The level of pain (VAS) after treatment was assessed in group 1, median (IQR): 2 (2-3) points, in group 2 4.5 (4-5) points; and the observed difference was also statistically significant (<i>p</i> < 0.001). In group 1, after treatment, the area of ulcers decreased-median (IQR): 33.05 (28.7-41.48) %, in group 2 by 18.99 (15-24.4) % (<i>p</i> < 0.001). In group 1, the pain intensity measured using the VAS scale decreased with a median (IQR): 71.42 (61.25-71.42) %, in group 2: 37.5 (28.57-50) % (<i>p</i> < 0.001). Complex therapy with polarized light therapy added to standard care was more effective than standard care alone in reducing of ulcers surface area and intensity of pain ailments in patients with chronic venous leg ulcers.</p>","PeriodicalId":94229,"journal":{"name":"The international journal of lower extremity wounds","volume":" ","pages":"718-725"},"PeriodicalIF":1.5,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141736231","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Predictive Value of Neutrophil-to-Lymphocyte Ratio (NLR) for Amputation in Patients with Diabetic Foot Ulcer: A Meta-Analysis.","authors":"Ruibin Feng, Cairu Chen, Qikai Hua","doi":"10.1177/15347346261483973","DOIUrl":"https://doi.org/10.1177/15347346261483973","url":null,"abstract":"<p><p>Diabetic foot ulcers frequently lead to amputation, and early risk identification remains challenging. Although the neutrophil-to-lymphocyte ratio (NLR) may predict amputation risk, supporting evidence remains limited. This study evaluated the association between NLR and amputation risk in patients with diabetic foot (DF). We systematically searched PubMed, Embase, Scopus, Cochrane Library, and Web of Science up to May 31, 2026. Studies reporting NLR value in DF patients with and without amputation were included. The primary outcome was the pooled mean difference (MD) in NLR between groups. Additionally, We performed a diagnostic accuracy analysis extracting sensitivity and specificity. Odds ratios (ORs) for amputation based on NLR were summarized descriptively. Study quality was assessed with the Newcastle-Ottawa Scale (NOS). Fifteen studies comprising 2757 patients were included. The amputation group had significantly higher NLR than the non-amputation group (pooled MD 3.66, 95% CI 2.60-4.71; I² = 81%). For major versus minor amputation, the pooled MD was 4.00 (95% CI 1.81-6.19; I² = 96%). Diagnostic analysis showed moderate discriminatory ability (area under the curve [AUC] 0.798), with a pooled sensitivity of 0.71 (95% CI 0.66-0.75), specificity of 0.71 (95% CI 0.66-0.75), and a diagnostic odds ratio of 6.85 (95% CI 3.54-13.27). Furthermore, studies reporting ORs indicated a positive association between elevated NLR and amputation risk. In conclusion, elevated NLR is significantly associated with amputation risk in DF patients, including major versus minor amputation. Diagnostic analysis suggests moderate discriminatory ability. However, substantial heterogeneity was observed across studies, which warrants caution in interpreting the pooled estimates. Despite this limitation, NLR remains a valuable, cost-effective biomarker for identifying high-risk patients, particularly in resource-limited settings.</p>","PeriodicalId":94229,"journal":{"name":"The international journal of lower extremity wounds","volume":" ","pages":"15347346261483973"},"PeriodicalIF":1.5,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148868634","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}