{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,15]],"date-time":"2026-07-15T14:38:58Z","timestamp":1784126338645,"version":"3.55.0"},"reference-count":35,"publisher":"SAGE Publications","issue":"1","license":[{"start":{"date-parts":[[2023,9,13]],"date-time":"2023-09-13T00:00:00Z","timestamp":1694563200000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/journals.sagepub.com\/page\/policies\/text-and-data-mining-license"}],"content-domain":{"domain":["journals.sagepub.com"],"crossmark-restriction":true},"short-container-title":["The International Journal of Lower Extremity Wounds"],"published-print":{"date-parts":[[2026,3]]},"abstract":"<jats:sec>\n                    <jats:title>Objective<\/jats:title>\n                    <jats:p>Diabetic ulcers are a prevalent complication of diabetes mellitus and represent one of the most complex and severe complications that can occur in diabetic patients. Most existing studies have separately examined the neutrophil-to-lymphocyte ratio (NLR) prognostic value or the platelet-to-lymphocyte ratio (PLR). However, to our knowledge, no study has evaluated the relationship between the monocyte-to-lymphocyte ratio (MLR) and non-healing lower extremity ulcers (NHLU) in patients. This study explored the association between 3 hematological parameters (MLR, NLR, and PLR) and the risk of non-healing ulceration in patients with type 2 diabetes (T2D).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>A cross-sectional study was performed using data from the National Health and Nutrition Examination Survey (NHANES) spanning 1999 to 2004. The primary outcome variable was NHLU status, determined by patients\u2019 self-reported responses to the question, \u201cHave you had an ulcer or sore on your leg or foot that took more than four weeks to heal?\u201d Logistic regression examined the relationships between MLR, NLR, PLR, and NHLU. Stratified analyses were also conducted based on age, gender, hemoglobin (HGB) level, and body mass index (BMI).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      In the multivariate regression models, after adjusting for age, sex, race\/ethnicity, marital status, poverty income ratio (PIR), BMI, HGB, family history of diabetes, and low-density lipoprotein (model 3), the odds ratios (ORs) of MLR and NLR were 1.21 (1.09-1.33) and 1.02 (1.01-1.03), respectively. However, the association was no longer statistically significant for the NLR (OR\u2009=\u20091.0002, 95% CI: 0.99-1.0005,\n                      <jats:italic toggle=\"yes\">P<\/jats:italic>\n                      \u2009=\u2009.137). In the subgroup analysis, the effect sizes of MLR and NLR on the presence of NHLU were stable in all subgroups (all\n                      <jats:italic toggle=\"yes\">P<\/jats:italic>\n                      \u2009&gt;\u2009.05).\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>After adjusting for confounding variables, MLR and NLR were significantly increased in T2D participants with NHLU. They may play a significant role in monitoring T2D patients during follow-up visits.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1177\/15347346231197884","type":"journal-article","created":{"date-parts":[[2023,9,13]],"date-time":"2023-09-13T03:24:42Z","timestamp":1694575482000},"page":"141-149","update-policy":"https:\/\/doi.org\/10.1177\/sage-journals-update-policy","source":"Crossref","is-referenced-by-count":7,"title":["Association of Monocyte to Lymphocyte, Neutrophil to Lymphocyte, and Platelet to Lymphocyte Ratios With Non-Healing Lower Extremity Ulcers in Patients With Type 2 Diabetes"],"prefix":"10.1177","volume":"25","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-9253-9083","authenticated-orcid":false,"given":"Hai","family":"Gao","sequence":"first","affiliation":[{"name":"Department of Plastic and Cosmetic Surgery, The Second Affiliated Hospital of Nanchang University, Nanchang, China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4070-6297","authenticated-orcid":false,"given":"Yangyan","family":"Yi","sequence":"additional","affiliation":[{"name":"Department of Plastic and Cosmetic Surgery, The Second Affiliated Hospital of Nanchang University, Nanchang, China"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"179","published-online":{"date-parts":[[2023,9,13]]},"reference":[{"key":"e_1_3_2_2_2","doi-asserted-by":"publisher","DOI":"10.2337\/dci22-0043"},{"issue":"11","key":"e_1_3_2_3_2","article-title":"Current therapeutic strategies in diabetic foot ulcers","volume":"55","author":"Aurelio PF","year":"2019","unstructured":"Aurelio PF, Margarita MF, Jessica G RL, et al. Current therapeutic strategies in diabetic foot ulcers. Med Kaunas Lith. 2019;55(11).","journal-title":"Med Kaunas Lith."},{"key":"e_1_3_2_4_2","doi-asserted-by":"publisher","DOI":"10.5114\/amsad.2021.107817"},{"issue":"7","key":"e_1_3_2_5_2","article-title":"Cost-effectiveness of interventions to manage diabetes: has the evidence changed since 2008?","volume":"43","author":"Siegal KR","year":"2020","unstructured":"Siegal KR, Ali MK, Zhou X, et al. Cost-effectiveness of interventions to manage diabetes: has the evidence changed since 2008? Diabetes Care. 2020;43(7).","journal-title":"Diabetes Care."},{"key":"e_1_3_2_6_2","doi-asserted-by":"publisher","DOI":"10.2337\/dc10-0843"},{"key":"e_1_3_2_7_2","doi-asserted-by":"publisher","DOI":"10.12968\/jowc.2018.27.Sup4.S6"},{"key":"e_1_3_2_8_2","doi-asserted-by":"publisher","DOI":"10.5312\/wjo.v6.i1.62"},{"key":"e_1_3_2_9_2","doi-asserted-by":"publisher","DOI":"10.1371\/journal.pone.0267412"},{"key":"e_1_3_2_10_2","doi-asserted-by":"publisher","DOI":"10.34067\/KID.0007922021"},{"key":"e_1_3_2_11_2","doi-asserted-by":"publisher","DOI":"10.1080\/14737159.2022.2049248"},{"key":"e_1_3_2_12_2","doi-asserted-by":"publisher","DOI":"10.1155\/2020\/9731854"},{"key":"e_1_3_2_13_2","doi-asserted-by":"publisher","DOI":"10.2147\/DMSO.S284583"},{"key":"e_1_3_2_14_2","doi-asserted-by":"publisher","DOI":"10.1002\/jcla.23719"},{"issue":"1","key":"e_1_3_2_15_2","article-title":"The association of the neutrophil-lymphocyte ratio with the outcome of diabetic foot ulcer","volume":"15","author":"Sathvik M","year":"2023","unstructured":"Sathvik M, Vuppuluri K, Dulipala P. The association of the neutrophil-lymphocyte ratio with the outcome of diabetic foot ulcer. Cureus. 2023;15(1).","journal-title":"Cureus."},{"key":"e_1_3_2_16_2","doi-asserted-by":"publisher","DOI":"10.2337\/dc10-S011"},{"key":"e_1_3_2_17_2","doi-asserted-by":"publisher","DOI":"10.1186\/s12967-022-03425-4"},{"key":"e_1_3_2_18_2","doi-asserted-by":"publisher","DOI":"10.1002\/jcla.23719"},{"key":"e_1_3_2_19_2","doi-asserted-by":"publisher","DOI":"10.3390\/ijms17122085"},{"key":"e_1_3_2_20_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.imbio.2012.01.008"},{"key":"e_1_3_2_21_2","doi-asserted-by":"publisher","DOI":"10.1161\/01.STR.0000130857.19423.ad"},{"key":"e_1_3_2_22_2","doi-asserted-by":"publisher","DOI":"10.1038\/nri3399"},{"key":"e_1_3_2_23_2","doi-asserted-by":"publisher","DOI":"10.1172\/JCI27196"},{"key":"e_1_3_2_24_2","doi-asserted-by":"publisher","DOI":"10.1002\/2327-6924.12366"},{"key":"e_1_3_2_25_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.jvs.2016.08.108"},{"key":"e_1_3_2_26_2","doi-asserted-by":"publisher","DOI":"10.1177\/1932296816658054"},{"key":"e_1_3_2_27_2","doi-asserted-by":"publisher","DOI":"10.1186\/s12933-018-0703-2"},{"key":"e_1_3_2_28_2","doi-asserted-by":"publisher","DOI":"10.1111\/dom.12422"},{"issue":"1","key":"e_1_3_2_29_2","article-title":"Lower limb ischaemia in patients with diabetic foot ulcers and gangrene: recognition, anatomic patterns and revascularization strategies","volume":"32","author":"Mills JL","year":"2016","unstructured":"Mills JL. Lower limb ischaemia in patients with diabetic foot ulcers and gangrene: recognition, anatomic patterns and revascularization strategies. Diabetes Metab Res Rev. 2016;32(Suppl 1).","journal-title":"Diabetes Metab Res Rev"},{"issue":"1","key":"e_1_3_2_30_2","article-title":"Diabetes mellitus-definition, classification, diagnosis, screening and prevention (Update 2019)","volume":"131","author":"Harreiter J","year":"2019","unstructured":"Harreiter J, Roden M. Diabetes mellitus-definition, classification, diagnosis, screening and prevention (Update 2019). Wien Klin Wochenschr. 2019;131(Suppl 1).","journal-title":"Wien Klin Wochenschr"},{"key":"e_1_3_2_31_2","doi-asserted-by":"crossref","unstructured":"(2) Classification and diagnosis of diabetes. Diabetes Care. 2015;38(Suppl).","DOI":"10.1515\/9781938549205-011"},{"key":"e_1_3_2_32_2","doi-asserted-by":"publisher","DOI":"10.2174\/1570161117666190405165151"},{"issue":"2","key":"e_1_3_2_33_2","article-title":"Diabetic foot infections: a comprehensive overview","volume":"23","author":"Pitocco D","year":"2019","unstructured":"Pitocco D, Spanu T, Di Leo M, et al. Diabetic foot infections: a comprehensive overview. Eur Rev Med Pharmacol Sci. 2019;23(2 Suppl).","journal-title":"Eur Rev Med Pharmacol Sci"},{"key":"e_1_3_2_34_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.cca.2016.12.007"},{"key":"e_1_3_2_35_2","doi-asserted-by":"publisher","DOI":"10.1177\/1534734617696729"},{"issue":"3","key":"e_1_3_2_36_2","article-title":"Neutrophil to lymphocyte ratio and platelet to lymphocyte ratio are associated with lower extremity vascular lesions in chinese patients with type 2 diabetes","volume":"65","author":"Liu N","year":"2019","unstructured":"Liu N, Sheng J, Pan T, Wang Y. Neutrophil to lymphocyte ratio and platelet to lymphocyte ratio are associated with lower extremity vascular lesions in chinese patients with type 2 diabetes. 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