{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,11,1]],"date-time":"2026-11-01T22:26:40Z","timestamp":1793572000567,"version":"4.5.0"},"reference-count":42,"publisher":"SAGE Publications","issue":"4","license":[{"start":{"date-parts":[[2025,7,3]],"date-time":"2025-07-03T00:00:00Z","timestamp":1751500800000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/journals.sagepub.com\/page\/policies\/text-and-data-mining-license"}],"funder":[{"DOI":"10.13039\/501100005089","name":"Natural Science Foundation of Beijing Municipality","doi-asserted-by":"publisher","award":["7252229"],"award-info":[{"award-number":["7252229"]}],"id":[{"id":"10.13039\/501100005089","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["journals.sagepub.com"],"crossmark-restriction":true},"short-container-title":["The International Journal of Lower Extremity Wounds"],"published-print":{"date-parts":[[2026,12]]},"abstract":"<jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Diabetic foot ulcer (DFU) is a common and serious complication of diabetes mellitus, with high rates of disability and mortality. Early diagnosis and prevention can effectively reduce its incidence. The relationship between hemoglobin, albumin, lymphocyte count, and platelet (HALP) score, which are biomarkers reflecting the inflammatory and nutritional status of the body, and DFU has not been investigated. This study aimed to investigate the association between HALP score and DFU.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>This cross-sectional study used data from the National Health and Nutrition Examination Survey (NHANES) from 1999 to 2004. Logistic regression models assessed the relationship between HALP scores (as both continuous and categorical variables) and DFU, adjusting for confounders. Restricted cubic spline (RCS) analysis was employed to evaluate potential non-linear relationships. Subgroup and sensitivity analyses were conducted to ensure the robustness of the findings.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>A total of 1604 participants (mean age: 61.67\u2009\u00b1\u200911.88 years; 52.9% male) were included. Multivariate logistic regression analysis, after adjusting for multiple confounders, revealed a negative correlation between the HALP score and DFU (OR = 0.98, 95% CI: 0.97\u20130.99, P\u2009=\u20090.041). This association remained significant when the HALP was categorized into quartiles. RCS analysis identified a non-linear relationship, with an inflection point at 44.98 (non-linear P\u2009=\u20090.017). Subgroup analyses confirmed the consistency of these findings across different demographic and clinical groups. Sensitivity analysis excluding extreme outliers confirmed the stability and reliability of the results.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>Lower HALP scores are significantly associated with an increased risk of DFU. This study underscores the potential utility of the HALP score as a tool for identifying individuals at higher risk, supporting its use in the prevention and management of DFU.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1177\/15347346251355578","type":"journal-article","created":{"date-parts":[[2025,7,3]],"date-time":"2025-07-03T03:11:18Z","timestamp":1751512278000},"page":"1330-1339","update-policy":"https:\/\/doi.org\/10.1177\/sage-journals-update-policy","source":"Crossref","is-referenced-by-count":6,"title":["Association Between Hemoglobin, Albumin, Lymphocyte, and Platelet Score and Diabetic Foot Ulcer: A Cross-Sectional Study"],"prefix":"10.1177","volume":"25","author":[{"given":"Zunwang","family":"Li","sequence":"first","affiliation":[{"name":"Beijing University of Chinese Medicine"},{"name":"Department of Orthopedics, Beijing University of Chinese Medicine Third Affiliated Hospital, Beijing, China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hui","family":"Guo","sequence":"additional","affiliation":[{"name":"Beijing University of Chinese Medicine"},{"name":"Department of Orthopedics, Beijing University of Chinese Medicine Third Affiliated Hospital, Beijing, China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Zhihong","family":"Fu","sequence":"additional","affiliation":[{"name":"Beijing University of Chinese Medicine"},{"name":"Department of Orthopedics, Beijing University of Chinese Medicine Third Affiliated Hospital, Beijing, China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Dongxiao","family":"Li","sequence":"additional","affiliation":[{"name":"Beijing University of Chinese Medicine"},{"name":"Department of Orthopedics, Beijing University of Chinese Medicine Third Affiliated Hospital, Beijing, China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yunhui","family":"Zhang","sequence":"additional","affiliation":[{"name":"Beijing University of Chinese Medicine"},{"name":"Department of Orthopedics, Beijing University of Chinese Medicine Third Affiliated Hospital, Beijing, China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ruizheng","family":"Zhu","sequence":"additional","affiliation":[{"name":"Beijing University of Chinese Medicine"},{"name":"Department of Orthopedics, Beijing University of Chinese Medicine Third Affiliated Hospital, Beijing, China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Junde","family":"Wu","sequence":"additional","affiliation":[{"name":"Department of Orthopedics, Beijing University of Chinese Medicine Third Affiliated Hospital, Beijing, China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0005-9636-9578","authenticated-orcid":false,"given":"Zhaojun","family":"Chen","sequence":"additional","affiliation":[{"name":"Department of Orthopedics, Beijing University of Chinese Medicine Third Affiliated Hospital, Beijing, China"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"179","published-online":{"date-parts":[[2025,7,3]]},"reference":[{"key":"e_1_3_2_2_2","doi-asserted-by":"publisher","DOI":"10.1016\/S0140-6736(23)01301-6"},{"key":"e_1_3_2_3_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.dsx.2022.102397"},{"key":"e_1_3_2_4_2","doi-asserted-by":"publisher","DOI":"10.1111\/dom.14840"},{"key":"e_1_3_2_5_2","doi-asserted-by":"publisher","DOI":"10.2337\/dc19-1614"},{"issue":"1","key":"e_1_3_2_6_2","article-title":"Practical Guidelines on the prevention and management of diabetic foot disease (IWGDF 2019 update)","volume":"36","author":"Schaper NC","year":"2020","unstructured":"Schaper NC, van Netten JJ, Apelqvist J, et al. Practical Guidelines on the prevention and management of diabetic foot disease (IWGDF 2019 update). Diabetes Metab Res Rev. 2020;36(Suppl 1):e3266. doi:https:\/\/doi.org\/10.1002\/dmrr.3266","journal-title":"Diabetes Metab Res Rev"},{"key":"e_1_3_2_7_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.jdiacomp.2024.108865"},{"key":"e_1_3_2_8_2","doi-asserted-by":"publisher","DOI":"10.37757\/MR2021.V23.N3.8"},{"key":"e_1_3_2_9_2","doi-asserted-by":"publisher","DOI":"10.1038\/s41598-024-65188-w"},{"key":"e_1_3_2_10_2","doi-asserted-by":"publisher","DOI":"10.1038\/s41387-024-00290-6"},{"key":"e_1_3_2_11_2","doi-asserted-by":"publisher","DOI":"10.1007\/s40200-023-01327-w"},{"key":"e_1_3_2_12_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.biopha.2020.110991"},{"key":"e_1_3_2_13_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.jtv.2024.09.007"},{"key":"e_1_3_2_14_2","doi-asserted-by":"publisher","DOI":"10.1111\/iwj.14019"},{"key":"e_1_3_2_15_2","first-page":"153473462413091","article-title":"Association between systemic immune-inflammatory index (SIRI) and diabetic foot ulcers in individuals with diabetes: Evidence from the NHANES","volume":"19","author":"Liu B","year":"2024","unstructured":"Liu B, Wang L, He Y. Association between systemic immune-inflammatory index (SIRI) and diabetic foot ulcers in individuals with diabetes: Evidence from the NHANES. Int J Low Extrem Wounds. 2024;19:15347346241309180. doi:https:\/\/doi.org\/10.1177\/15347346241309180","journal-title":"Int J Low Extrem Wounds"},{"key":"e_1_3_2_16_2","doi-asserted-by":"publisher","DOI":"10.3389\/fendo.2024.1387218"},{"key":"e_1_3_2_17_2","doi-asserted-by":"publisher","DOI":"10.1097\/WON.0000000000000780"},{"key":"e_1_3_2_18_2","doi-asserted-by":"publisher","DOI":"10.3390\/diagnostics14070738"},{"key":"e_1_3_2_19_2","doi-asserted-by":"publisher","DOI":"10.18632\/oncotarget.5629"},{"key":"e_1_3_2_20_2","doi-asserted-by":"publisher","DOI":"10.2147\/JIR.S461961"},{"key":"e_1_3_2_21_2","doi-asserted-by":"publisher","DOI":"10.1038\/s41598-024-66667-w"},{"key":"e_1_3_2_22_2","doi-asserted-by":"publisher","DOI":"10.1177\/10815589241273682"},{"key":"e_1_3_2_23_2","doi-asserted-by":"publisher","DOI":"10.3389\/fendo.2024.1356929"},{"issue":"1","key":"e_1_3_2_24_2","article-title":"2. Classification and diagnosis of diabetes: Standards of medical care in diabetes-2021","volume":"44","author":"American Diabetes Association","year":"2021","unstructured":"American Diabetes Association. 2. Classification and diagnosis of diabetes: Standards of medical care in diabetes-2021. Diabetes Care. 2021;44(Suppl 1):S15-S33. doi:https:\/\/doi.org\/10.2337\/dc21-S002","journal-title":"Diabetes Care"},{"key":"e_1_3_2_25_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.pmedr.2023.102433"},{"key":"e_1_3_2_26_2","doi-asserted-by":"publisher","DOI":"10.1155\/2022\/5450173"},{"key":"e_1_3_2_27_2","doi-asserted-by":"publisher","DOI":"10.1136\/bmjdrc-2023-003523"},{"key":"e_1_3_2_28_2","first-page":"153473462513437","article-title":"Chronic kidney disease as an independent risk factor for chronic lower extremity ulcers: A cross-sectional analysis of US adults","author":"Gao H","year":"2025","unstructured":"Gao H, Yang J, Wang Z, Wu S, Yi Y. Chronic kidney disease as an independent risk factor for chronic lower extremity ulcers: A cross-sectional analysis of US adults. Int J Low Extrem Wounds. 2025:15347346251343707. doi:https:\/\/doi.org\/10.1177\/15347346251343707","journal-title":"Int J Low Extrem Wounds"},{"key":"e_1_3_2_29_2","doi-asserted-by":"publisher","DOI":"10.1038\/s41598-021-98565-w"},{"key":"e_1_3_2_30_2","doi-asserted-by":"publisher","DOI":"10.1111\/j.1463-1326.2005.00516.x"},{"key":"e_1_3_2_31_2","doi-asserted-by":"publisher","DOI":"10.1001\/jama.2023.10578"},{"key":"e_1_3_2_32_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.jdiacomp.2015.10.002"},{"key":"e_1_3_2_33_2","doi-asserted-by":"publisher","DOI":"10.3390\/antiox8090367"},{"key":"e_1_3_2_34_2","doi-asserted-by":"publisher","DOI":"10.1093\/jn\/133.1.336S"},{"key":"e_1_3_2_35_2","doi-asserted-by":"publisher","DOI":"10.3389\/fnut.2022.851274"},{"key":"e_1_3_2_36_2","doi-asserted-by":"publisher","DOI":"10.3390\/nu14122393"},{"key":"e_1_3_2_37_2","doi-asserted-by":"publisher","DOI":"10.3390\/nu13072210"},{"issue":"2","key":"e_1_3_2_38_2","article-title":"Diabetes and anemia: International Diabetes Federation (IDF) - Southeast Asian Region (SEAR) position statement","volume":"11","author":"Sahay M","year":"2017","unstructured":"Sahay M, Kalra S, Badani R, et al. Diabetes and anemia: International Diabetes Federation (IDF) - Southeast Asian Region (SEAR) position statement. Diabetes Metab Syndr. 2017;11(Suppl 2):S685-S695. doi:https:\/\/doi.org\/10.1016\/j.dsx.2017.04.026","journal-title":"Diabetes Metab Syndr"},{"key":"e_1_3_2_39_2","doi-asserted-by":"publisher","DOI":"10.1186\/s12933-015-0261-9"},{"key":"e_1_3_2_40_2","doi-asserted-by":"publisher","DOI":"10.1177\/1534734619876779"},{"key":"e_1_3_2_41_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.cvsm.2020.07.005"},{"key":"e_1_3_2_42_2","doi-asserted-by":"publisher","DOI":"10.3389\/fimmu.2015.00083"},{"key":"e_1_3_2_43_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.rpth.2023.102209"}],"container-title":["The International Journal of Lower Extremity Wounds"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/journals.sagepub.com\/doi\/pdf\/10.1177\/15347346251355578","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/journals.sagepub.com\/doi\/full-xml\/10.1177\/15347346251355578","content-type":"application\/xml","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/journals.sagepub.com\/doi\/pdf\/10.1177\/15347346251355578","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,11,1]],"date-time":"2026-11-01T21:40:45Z","timestamp":1793569245000},"score":1,"resource":{"primary":{"URL":"https:\/\/journals.sagepub.com\/doi\/10.1177\/15347346251355578"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,7,3]]},"references-count":42,"journal-issue":{"issue":"4","published-print":{"date-parts":[[2026,12]]}},"alternative-id":["10.1177\/15347346251355578"],"URL":"https:\/\/doi.org\/10.1177\/15347346251355578","relation":{},"ISSN":["1534-7346","1552-6941"],"issn-type":[{"value":"1534-7346","type":"print"},{"value":"1552-6941","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,7,3]]}}}