Prognostic Value Of Serum 25 Hydroxyvitamin D In Patients With Diabetes Foot Ulcer

Background:Diabetes has changed from a rare disease to an epidemic disease in our country,and the prevalence of diabetes foot has also increased significantly.The incidence rate of diabetes foot among diabetes patients over 50 years old in our country is as high as8.1%.Diabetes foot ulcer is one of the most serious complications of diabetes,which is also the main cause of disability and death in diabetes patients.Improving the evaluation system for the prognosis of diabetes foot ulcers as well as digging out accurate and effective prognostic prediction indicators is extremely urgent.And precise treatment according to Individual condition could improve the prognosis of diabetes foot ulcer.Vitamin D deficiency and deficiency is one of the global public health problems,and epidemiological data shows that vitamin D deficiency is widespread in the Chinese population.In recent years,studies on the relationship between vitamin D and diabetes and its complications have attracted more and more attention.Previous studies have confirmed that the serum 25 hydroxyvitamin D [25(OH)D] in patients with diabetes foot ulcer is more insufficient or deficient compared with those without foot ulcer,suggesting the correlation between the serum 25(OH)D level and the severity of diabetes foot ulcer,but the predictive value of the serum 25(OH)D level on the wound prognosis in patients with diabetes foot ulcer is still unclear.At present,there is little research on the relationship between serum 25(OH)D level and the prognosis of type 2 diabetes foot ulcer patients.Therefore,this study selected patients with type 2 diabetes foot ulcer over 18 years old,collected clinical data,analyzed the distribution characteristics of serum 25(OH)D in type 2 diabetes foot ulcer patients,preliminarily explored the relationship between serum 25(OH)D level and the severity of type 2 diabetes foot ulcer patients,and analyzed the prognostic factors affecting type 2 diabetes foot ulcer patients.This study provides convenient,rapid and economic prediction indicators for the treatment and prognosis of type 2 diabetes foot ulcer patients,which is of great significance for guiding clinical treatment.Objective1.To analyze the correlation between serum 25(OH)D level and the severity of foot ulcer in type 2 diabetes patients;2.To understand the effect of serum 25(OH)D level on the prognosis of type 2 diabetes foot ulcer patients;3.To explore the predictive value of serum 25(OH)D level for the prognosis of foot ulcer in type 2diabetes patients.MethodsThe clinical data of 734 patients with diabetes foot ulcer admitted to the Endocrinology Department of the PLA Strategic Support Force Medical Center(The306th Hospital of PLA)from January 2016 to January 2021 were collected.According to the strict inclusion and exclusion criteria,453 patients were included in this study and collected general information and laboratory examination.General information mainly included gender,age,previous history,foot ulcer site,ulcer area,ulcer depth,concurrent infection,complications,etc.Laboratory examination included white blood cells(WBC),percentage of neutrophils(NE%),hemoglobin(Hb),fasting blood glucose(FPG),2-hour postprandial blood glucose(2PG),glycosylated hemoglobin(Hb A1c)total cholesterol(TC),high-density lipoprotein cholesterol(HDL-C),lowdensity lipoprotein cholesterol(LDL-C),albumin(ALB),C-reactive protein(CRP)and 25(OH)D.The severity of foot ulcer of type 2 diabetes patients was evaluated by Wagner grading system.Patients with Wagner grading of 1～2 were defined as mild group,and patients with ≥ 3 grades were defined as severe group.The difference of laboratory examination between mild and severe group was compared,and the correlation and the severity of ulcer was analyzed between two groups.Patients were followed up for 6 months after discharge.According to the follow-up results,the type2 diabetes foot ulcer patients were divided into two subgroups: good prognosis group and poor prognosis group.General data and laboratory results of between two subgroups were analyzed and probable prognostic factors were determined.The ROC of subjects was drawn to evaluate the predictive value of 25(OH)D and other laboratory indicators on the prognosis of foot ulcer in patients with type 2 diabetes.Results1.453 patients with type 2 diabetes foot ulcer were finally enrolled,including310 males(68.4%)and 143 females(31.6%),with a male female ratio of 2.17:1.Disease course ranged from 1 to 492 months,and average level of 25(OH)D is 11.45± 3.83 ng/ml.In terms of complications,285 cases(62.9%)were complicated with retinopathy,242 cases(53.6%)were complicated with diabetes nephropathy,366cases(80.8%)were complicated with lower limb angiopathy,326 cases(72.0%)were complicated with peripheral neuropathy,and 431 cases(95.1%)were complicated with ≥ 1 cardiovascular diseases.2.There were 195 cases(43.0%)in the mild group and 258 cases(57.0%)in the severe group.There was no statistically significant difference in neutrophil percentage,fasting blood glucose,Hb A1 c,TC,HDL-C,and LDL-C levels between the two groups(p>0.05).The white blood cells,2-hour postprandial blood glucose,and CRP levels in the mild group were significantly lower than those in the severe group,with a statistically significant difference(p <0.05).The levels of hemoglobin,albumin,and25(OH)D were significantly higher than those in the severe group,The difference was statistically significant(p <0.05).3.Correlation analysis showed that Wagner’s grading was positively correlated with white blood cells(r=0.151),2-hour postprandial blood glucose(r=0.186),and CRP(r=0.218)(p <0.05),but negatively correlated with hemoglobin(r=-0.178),albumin(r=-0.121),25(OH)D(r=-0.236)(p <0.05),and not significantly correlated with neutrophil percentage,TC,fasting blood glucose,Hb1 Ac,HDL-C,and LDL-C(p >0.05).4.After 6-month follow-up,out of 195 mild patients,155 patients had a good prognosis and 40 patients had a poor prognosis;Among the 258 patients in the severe group,there were 43 patients in the group with good prognosis and 215 patients in the group with poor prognosis.5.There was no statistically significant difference in the percentage of white blood cells,neutrophils,Hb A1 c,TC,HDL-C,and LDL-C between the two subgroups of patients in mild disease group(p >0.05),but fasting blood glucose,2-hour postprandial blood glucose,and CRP of patients in the good prognosis group were lower than those in the poor prognosis group,while the levels of hemoglobin,white protein,and 25(OH)D were higher than those in the poor prognosis group,with a statistically significant difference(p <0.05).There was no statistically significant difference in fasting blood glucose,Hb A1 c,TC,HDL-C,and LDL-C between the two subgroups of patients in the severe group(p >0.05).However,the percentage of white blood cells,neutrophils,2-hour postprandial blood glucose,and CRP in the patients with good prognosis were lower than those in the poor prognosis group,while the levels of hemoglobin,white egg white,and 25(OH)D were higher than those in the poor prognosis group,with a statistically significant difference(p <0.05).6.Logistic regression model was used in the mild group which showed that hemoglobin(OR=0.465),albumin(OR=0.735),25(OH)D(OR=0.691)were independent protective factors for the prognosis of mild type 2 diabetes foot ulcer patients(p <0.05);CRP(OR=3.772)was an independent risk factor for the prognosis of mild type 2 diabetes foot ulcer patients(p <0.05).Similarly,logistic regression model was used in the severe group,and the result showed that hemoglobin(OR=0.429),albumin(OR=0.505),25(OH)D(OR=0.690)were independent protective factors for the prognosis of severe type 2 diabetes foot ulcer patients(p<0.05);white blood cells(OR=1.684)and CRP(OR=3.976)were independent risk factors for the prognosis of patients with severe type 2 diabetes foot ulcer(p <0.05).7.ROC curve analysis showed that CRP(AUC=0.796)and 25(OH)D(AUC=0.750)had certain predictive value for the prognosis of mild type 2 diabetes foot ulcer patients(AUC>0.7,p <0.05),of which the predictive cutoff value of CRP was 31.79 mg/L,and the predictive cutoff value of 25(OH)D was 10.86 ng/ml;CRP(AUC=0.725)and 25(OH)D(AUC=0.701)had certain predictive value for the prognosis of patients with severe type 2 diabetes foot ulcer(AUC>0.7,p <0.05).The predictive cutoff value of CRP was 32.08 mg/L,and the predictive cutoff value of 25(OH)D was 11.16 ng/ml.Conclusion1.Vitamin D deficiency is common in type 2 diabetes foot ulcer patients,and 25(OH)D level in patients with severe ulcer is significantly lower than that in patients with mild ulcer,suggesting that 25(OH)D level is related to the severity of type 2diabetes foot ulcer patients.2.The level of 25(OH)D is an independent protective factor for poor prognosis of type 2 diabetes foot ulcer patients.Therefore,exogenous vitamin D can be properly supplemented in the treatment of type 2 diabetes foot ulcer patients,which may improve the occurrence of poor prognosis of foot ulcer to a certain extent.3.The 25(OH)D level has certain predictive value for poor prognosis of type 2diabetes foot ulcer patients,suggesting that clinical attention should be paid to the 25(OH)D level of type 2 diabetes foot ulcer patients.