{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,14]],"date-time":"2026-10-14T16:43:10Z","timestamp":1791996190616,"version":"4.4.0"},"reference-count":52,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2023,10,25]],"date-time":"2023-10-25T00:00:00Z","timestamp":1698192000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Public Health"],"abstract":"<jats:sec><jats:title>Background<\/jats:title><jats:p>Diabetic foot-induced sepsis is a serious complication associated with increased disability and mortality in hospitalized patients. Early prediction of admission and detection effectively improve treatment options and prevent further deterioration. This study aims to evaluate the clinical value of the neutrophil-to-lymphocyte ratio (NLR) and prognostic nutritional index (PNI) to predict the risk of sepsis in patients with diabetic foot ulcers (DFU).<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>Retrospective analysis was performed on 216 patients who were admitted to the Fujian Medical University Union Hospital between January 2015 and December 2022. Patients with DFU were divided into the non-sepsis (<jats:italic>n<\/jats:italic>\u2009=\u2009166) and the DFU-induced sepsis (<jats:italic>n<\/jats:italic>\u2009=\u200950) groups. The independent factors of DFU-induced sepsis were determined by univariate and multivariate logistic regression analyses. A receiver operating characteristic (ROC) curve was performed to compare the area under the curves (AUC) of PNI and NLR.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>Multivariate logistic regression analysis revealed that the PNI, NLR, international normalized ratio (INR), thrombin time (PT), and C-reactive protein (CRP) were independent prognostic factors for DFU-induced sepsis. After adjusting for potential confounders, the adjusted odds ratios of NLR for DFU-induced sepsis were 1.121 (1.072\u20131.172), 1.132 (1.077\u20131.189), and 1.080 (1.022\u20131.142), while those of PNI were 0.912 (0.873\u20130.953), 0.902 (0.856\u20130.950), and 1.004 (1.001\u20131.006). Moreover, the AUC of NLR was significantly greater than that of CRP (0.790, 95% CI: 0.689\u20130.891, <jats:italic>p<\/jats:italic>\u2009&amp;lt;\u20090.001 vs. 0.780, 95% CI: 0.686\u20130.873, <jats:italic>p<\/jats:italic>\u2009&amp;lt;\u20090.001).<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusion<\/jats:title><jats:p>NLR and PNI have been regarded as readily and independently predictive markers in patients with DFU-induced sepsis. NLR is critical for the early detection and effective treatment of DFU-induced sepsis and is superior to CRP.<\/jats:p><\/jats:sec>","DOI":"10.3389\/fpubh.2023.1181880","type":"journal-article","created":{"date-parts":[[2023,10,25]],"date-time":"2023-10-25T10:20:30Z","timestamp":1698229230000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":24,"title":["Clinical value of neutrophil-to-lymphocyte ratio and prognostic nutritional index on prediction of occurrence and development of diabetic foot-induced sepsis"],"prefix":"10.3389","volume":"11","author":[{"given":"Bing","family":"Sun","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yimin","family":"Chen","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yulin","family":"Man","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yu","family":"Fu","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jianchang","family":"Lin","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Zhaohong","family":"Chen","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1965","published-online":{"date-parts":[[2023,10,25]]},"reference":[{"key":"ref1","doi-asserted-by":"publisher","first-page":"55","DOI":"10.1007\/s11154-015-9309-0","article-title":"The role of gut microbiota in the development of type 1, type 2 diabetes mellitus and obesity","volume":"16","author":"Tai","year":"2015","journal-title":"Rev Endocr Metab Disord"},{"key":"ref2","doi-asserted-by":"publisher","first-page":"196","DOI":"10.1186\/s13054-019-2478-6","article-title":"Frequency and mortality of septic shock in Europe and North America: a systematic review and meta-analysis","volume":"23","author":"Vincent","year":"2019","journal-title":"Crit Care"},{"key":"ref3","doi-asserted-by":"publisher","first-page":"221","DOI":"10.1007\/s00592-019-01412-8","article-title":"Incidence of hospitalization and mortality in patients with diabetic foot regardless of amputation: a population study","volume":"57","author":"Monge","year":"2020","journal-title":"Acta Diabetol"},{"key":"ref4","doi-asserted-by":"publisher","first-page":"771","DOI":"10.2337\/dc10-1185","article-title":"Diabetes and sepsis: preclinical findings and clinical relevance","volume":"34","author":"Schuetz","year":"2011","journal-title":"Diabetes Care"},{"key":"ref5","first-page":"699","article-title":"Histopathological changes in major amputations due to diabetic foot - a review","volume":"59","author":"Gherman","year":"2018","journal-title":"Romanian J Morphol Embryol"},{"key":"ref6","first-page":"E25","article-title":"Hereditary sensory and autonomic neuropathy presenting with mutilating trophic ulcers","volume":"30","author":"Mathur","year":"2018","journal-title":"Wounds"},{"key":"ref7","doi-asserted-by":"publisher","first-page":"78","DOI":"10.1016\/j.avsg.2017.11.072","article-title":"Heel wounds predict mortality but not amputation after Infrapopliteal revascularization","volume":"51","author":"Mohapatra","year":"2018","journal-title":"Ann Vasc Surg"},{"key":"ref8","doi-asserted-by":"publisher","first-page":"1852","DOI":"10.2337\/dc15-0536","article-title":"Diabetes, lower-extremity amputation, and death","volume":"38","author":"Hoffstad","year":"2015","journal-title":"Diabetes Care"},{"key":"ref9","doi-asserted-by":"publisher","first-page":"5439521","DOI":"10.1155\/2016\/5439521","article-title":"Epidemiology of diabetic foot ulcers and amputations in Romania: results of a cross-sectional quality of life questionnaire based survey","volume":"2016","author":"Bondor","year":"2016","journal-title":"J Diabetes Res"},{"key":"ref10","doi-asserted-by":"publisher","first-page":"120","DOI":"10.3346\/jkms.2016.31.1.120","article-title":"Factors affecting length of hospital stay and mortality in infected diabetic foot ulcers undergoing surgical drainage without major amputation","volume":"31","author":"Kim","year":"2016","journal-title":"J Korean Med Sci"},{"key":"ref11","doi-asserted-by":"publisher","first-page":"291","DOI":"10.11622\/smedj.2018069","article-title":"Prevention of diabetic foot complications","volume":"59","author":"Nather","year":"2018","journal-title":"Singap Med J"},{"key":"ref12","doi-asserted-by":"publisher","first-page":"108222","DOI":"10.1016\/j.jdiacomp.2022.108222","article-title":"Amputation and infection are the greatest fears in patients with diabetes foot complications","volume":"36","author":"Wukich","year":"2022","journal-title":"J Diabetes Complicat"},{"key":"ref13","doi-asserted-by":"publisher","first-page":"1141","DOI":"10.1016\/j.jdiacomp.2018.09.013","article-title":"Mortality and complications after treatment of acute diabetic Charcot foot","volume":"32","author":"Jansen","year":"2018","journal-title":"J Diabetes Complicat"},{"key":"ref14","doi-asserted-by":"publisher","first-page":"92","DOI":"10.1016\/j.ejim.2020.12.025","article-title":"Italian Federation of Hospital Internists - Sepsis collaboration Group of the Tuscany R. Validity of \"Sepsis-3\" criteria in identifying patients with community-onset sepsis in internal medicine wards; a prospective, multicenter study","volume":"85","author":"Fortini","year":"2021","journal-title":"Eur J Intern Med"},{"key":"ref15","doi-asserted-by":"publisher","first-page":"039","DOI":"10.1055\/s-0041-1740975","article-title":"Sepsis and septic shock: evolving evidence, evolving paradigms","volume":"43","author":"Shorr","year":"2022","journal-title":"Semin Respir Crit Care Med"},{"key":"ref16","doi-asserted-by":"publisher","first-page":"1570","DOI":"10.12688\/f1000research.15758.1","article-title":"Recent advances in understanding and managing sepsis","volume":"7","author":"Berg","year":"2018","journal-title":"F1000Res"},{"key":"ref17","doi-asserted-by":"publisher","first-page":"1519","DOI":"10.1038\/s41430-020-0629-0","article-title":"Relationship between markers of malnutrition and clinical outcomes in older adults with cancer: systematic review, narrative synthesis and meta-analysis","volume":"74","author":"Bullock","year":"2020","journal-title":"Eur J Clin Nutr"},{"key":"ref18","doi-asserted-by":"publisher","first-page":"1301","DOI":"10.1007\/s10147-019-01461-7","article-title":"Clinical significance of prognostic nutritional index (PNI) in malignant melanoma","volume":"24","author":"Mirili","year":"2019","journal-title":"Int J Clin Oncol"},{"key":"ref19","doi-asserted-by":"publisher","DOI":"10.3390\/ijms22158002","article-title":"Inflammation-related biomarkers for the prediction of prognosis in colorectal Cancer patients","volume":"22","author":"Yamamoto","year":"2021","journal-title":"Int J Mol Sci"},{"key":"ref20","doi-asserted-by":"publisher","first-page":"1449758","DOI":"10.1155\/2022\/1449758","article-title":"Clinical value of prognostic nutritional index and neutrophil-to-lymphocyte ratio in prediction of the development of Sepsis-induced kidney injury","volume":"2022","author":"Xie","year":"2022","journal-title":"Dis Markers"},{"key":"ref21","doi-asserted-by":"publisher","first-page":"123","DOI":"10.3892\/etm.2020.9555","article-title":"Prognostic nutritional index predicts acute kidney injury and mortality of patients in the coronary care unit","volume":"21","author":"Hu","year":"2021","journal-title":"Exp Ther Med"},{"key":"ref22","doi-asserted-by":"publisher","first-page":"e22996","DOI":"10.1002\/jcla.22996","article-title":"Procalcitonin as a prognostic marker for sepsis based on SEPSIS-3","volume":"33","author":"Jekarl","year":"2019","journal-title":"J Clin Lab Anal"},{"key":"ref23","doi-asserted-by":"publisher","first-page":"857218","DOI":"10.3389\/fsurg.2022.857218","article-title":"Value of CRP, PCT, and NLR in prediction of severity and prognosis of patients with bloodstream infections and Sepsis","volume":"9","author":"Liang","year":"2022","journal-title":"Front Surg"},{"key":"ref24","doi-asserted-by":"publisher","first-page":"332","DOI":"10.7150\/ijms.39367","article-title":"Procalcitonin: a promising tool or just another overhyped test?","volume":"17","author":"Paudel","year":"2020","journal-title":"Int J Med Sci"},{"key":"ref25","doi-asserted-by":"publisher","first-page":"801","DOI":"10.1001\/jama.2016.0287","article-title":"The third international consensus definitions for Sepsis and septic shock (Sepsis-3)","volume":"315","author":"Singer","year":"2016","journal-title":"JAMA"},{"key":"ref26","doi-asserted-by":"publisher","first-page":"627","DOI":"10.2147\/IDR.S287852","article-title":"Nomogram model for predicting the risk of multidrug-resistant Bacteria infection in diabetic foot patients","volume":"14","author":"Ma","year":"2021","journal-title":"Infect Drug Resist"},{"key":"ref27","doi-asserted-by":"publisher","first-page":"555152","DOI":"10.3389\/fonc.2020.555152","article-title":"The fib-PNI-MLR score, an integrative model of coagulation cascades, nutrition status, and systemic inflammatory response, predicts urological outcomes after surgery in patients with non-metastatic renal cell carcinoma","volume":"10","author":"Gao","year":"2020","journal-title":"Front Oncol"},{"key":"ref28","doi-asserted-by":"publisher","first-page":"886","DOI":"10.21037\/tlcr.2019.11.16","article-title":"Prognostic biomarkers in stage IV non-small cell lung cancer (NSCLC): neutrophil to lymphocyte ratio (NLR), lymphocyte to monocyte ratio (LMR), platelet to lymphocyte ratio (PLR) and advanced lung cancer inflammation index (ALI)","volume":"8","author":"Mandaliya","year":"2019","journal-title":"Transl Lung Cancer Res"},{"key":"ref29","doi-asserted-by":"publisher","first-page":"1139","DOI":"10.1007\/s00592-021-01728-4","article-title":"Type 2 diabetes mellitus and sepsis: state of the art, certainties and missing evidence","volume":"58","author":"Costantini","year":"2021","journal-title":"Acta Diabetol"},{"key":"ref30","doi-asserted-by":"publisher","first-page":"222","DOI":"10.1016\/j.dsx.2012.02.026","article-title":"Sepsis in diabetes: a bad duo","volume":"5","author":"Tiwari","year":"2011","journal-title":"Diabetes Metab Syndr"},{"key":"ref31","doi-asserted-by":"publisher","first-page":"281","DOI":"10.1086\/431587","article-title":"Increased risk of common infections in patients with type 1 and type 2 diabetes mellitus","volume":"41","author":"Muller","year":"2005","journal-title":"Clin Infect Dis"},{"key":"ref32","doi-asserted-by":"publisher","first-page":"271","DOI":"10.3389\/fendo.2017.00271","article-title":"Diabetes and Sepsis: risk, recurrence, and ruination","volume":"8","author":"Frydrych","year":"2017","journal-title":"Front Endocrinol"},{"key":"ref33","doi-asserted-by":"publisher","first-page":"10760296211026385","DOI":"10.1177\/10760296211026385","article-title":"The Association of Coagulation Indicators and Coagulant Agents with 30-day mortality of critical diabetics","volume":"27","author":"Huang","year":"2021","journal-title":"Clin Appl Thromb Hemost"},{"key":"ref34","doi-asserted-by":"publisher","first-page":"2021","DOI":"10.2337\/dc12-0200","article-title":"Long-term prognosis of diabetic foot patients and their limbs: amputation and death over the course of a decade","volume":"35","author":"Morbach","year":"2012","journal-title":"Diabetes Care"},{"key":"ref35","doi-asserted-by":"publisher","first-page":"982","DOI":"10.1016\/j.jvs.2014.04.052","article-title":"Influence of foot ulceration on cause-specific mortality in patients with diabetes mellitus","volume":"60","author":"Brownrigg","year":"2014","journal-title":"J Vasc Surg"},{"key":"ref36","doi-asserted-by":"publisher","first-page":"626","DOI":"10.1007\/s00125-017-4488-8","article-title":"Risk of lower limb amputation in a national prevalent cohort of patients with diabetes","volume":"61","author":"Gurney","year":"2018","journal-title":"Diabetologia"},{"key":"ref37","doi-asserted-by":"publisher","first-page":"6621035","DOI":"10.1155\/2021\/6621035","article-title":"Development of predictive nomograms for clinical use to quantify the risk of amputation in patients with diabetic foot ulcer","volume":"2021","author":"Peng","year":"2021","journal-title":"J Diabetes Res"},{"key":"ref38","doi-asserted-by":"publisher","first-page":"2535","DOI":"10.1016\/j.clnu.2021.04.018","article-title":"Association between malnutrition and long-term mortality in older adults with ischemic stroke","volume":"40","author":"Yuan","year":"2021","journal-title":"Clin Nutr"},{"key":"ref39","doi-asserted-by":"publisher","first-page":"828","DOI":"10.1016\/j.jacc.2020.06.058","article-title":"Prevalence and prognostic significance of malnutrition in patients with acute coronary syndrome","volume":"76","author":"Raposeiras Roubin","year":"2020","journal-title":"J Am Coll Cardiol"},{"key":"ref40","doi-asserted-by":"publisher","first-page":"7181","DOI":"10.2147\/JIR.S343992","article-title":"Clinical value of prognostic nutritional index in prediction of the presence and severity of neonatal Sepsis","volume":"14","author":"Li","year":"2021","journal-title":"J Inflamm Res"},{"key":"ref41","doi-asserted-by":"publisher","first-page":"11","DOI":"10.7554\/eLife.72071","article-title":"Overriding impaired FPR chemotaxis signaling in diabetic neutrophil stimulates infection control in murine diabetic wound","volume":"11","author":"Roy","year":"2022","journal-title":"elife"},{"key":"ref42","doi-asserted-by":"publisher","first-page":"118","DOI":"10.1016\/j.diabres.2018.08.009","article-title":"The significance of neutrophil-lymphocyte ratio, platelet-lymphocyte ratio and lymphocyte-monocyte ratio in predicting peripheral arterial disease, peripheral neuropathy, osteomyelitis and amputation in diabetic foot infection","volume":"144","author":"Demirdal","year":"2018","journal-title":"Diabetes Res Clin Pract"},{"key":"ref43","doi-asserted-by":"publisher","first-page":"154157","DOI":"10.1016\/j.cyto.2017.09.013","article-title":"Platelet-derived chemokines in inflammation and atherosclerosis","volume":"122","author":"Bakogiannis","year":"2019","journal-title":"Cytokine"},{"key":"ref44","doi-asserted-by":"publisher","first-page":"1803","DOI":"10.1007\/s00421-021-04668-7","article-title":"Transferring clinically established immune inflammation markers into exercise physiology: focus on neutrophil-to-lymphocyte ratio, platelet-to-lymphocyte ratio and systemic immune-inflammation index","volume":"121","author":"Walzik","year":"2021","journal-title":"Eur J Appl Physiol"},{"key":"ref45","doi-asserted-by":"publisher","first-page":"15347346211057742","DOI":"10.1177\/15347346211057742","article-title":"Significance of neutrophil to lymphocyte ratio (NLR) and platelet lymphocyte ratio (PLR) in diabetic foot ulcer and potential new therapeutic targets","author":"Serban","year":"2021","journal-title":"Int J Low Extrem Wounds"},{"key":"ref46","doi-asserted-by":"publisher","first-page":"428","DOI":"10.1038\/nature07201","article-title":"Origin and physiological roles of inflammation","volume":"454","author":"Medzhitov","year":"2008","journal-title":"Nature"},{"key":"ref47","doi-asserted-by":"publisher","first-page":"304","DOI":"10.1016\/j.diabet.2015.01.001","article-title":"Impact of diabetes on neutrophil-to-lymphocyte ratio and its relationship to coronary artery disease","volume":"41","author":"Verdoia","year":"2015","journal-title":"Diabetes Metab"},{"key":"ref48","doi-asserted-by":"publisher","first-page":"507","DOI":"10.1016\/j.kjms.2016.08.008","article-title":"Significance of preoperative neutrophil-lymphocyte count ratio on predicting postoperative sepsis after percutaneous nephrolithotomy","volume":"32","author":"Sen","year":"2016","journal-title":"Kaohsiung J Med Sci"},{"key":"ref49","doi-asserted-by":"publisher","first-page":"194","DOI":"10.1055\/a-2009-6937","article-title":"Fasting plasma glucose increase and neutrophil-to-lymphocyte ratio as risk predictors of clinical outcome of COVID-19 pneumonia in type 2 diabetes mellitus","volume":"131","author":"Petrakis","year":"2023","journal-title":"Exp Clin Endocrinol Diabetes"},{"key":"ref50","doi-asserted-by":"publisher","first-page":"202","DOI":"10.1164\/rccm.202004-1201OC","article-title":"Procalcitonin to reduce long-term infection-associated adverse events in Sepsis. a randomized trial","volume":"203","author":"Kyriazopoulou","year":"2021","journal-title":"Am J Respir Crit Care Med"},{"key":"ref51","doi-asserted-by":"publisher","first-page":"968","DOI":"10.1186\/s12879-019-4618-7","article-title":"Diagnostic and prognostic value of interleukin-6, pentraxin 3, and procalcitonin levels among sepsis and septic shock patients: a prospective controlled study according to the Sepsis-3 definitions","volume":"19","author":"Song","year":"2019","journal-title":"BMC Infect Dis"},{"key":"ref52","doi-asserted-by":"publisher","first-page":"1283","DOI":"10.1016\/j.jvs.2017.02.060","article-title":"Potential of circulatory procalcitonin as a biomarker reflecting inflammation among south Indian diabetic foot ulcers","volume":"67","author":"Umapathy","year":"2018","journal-title":"J Vasc Surg"}],"container-title":["Frontiers in Public Health"],"original-title":[],"link":[{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fpubh.2023.1181880\/full","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2023,10,25]],"date-time":"2023-10-25T10:20:33Z","timestamp":1698229233000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fpubh.2023.1181880\/full"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2023,10,25]]},"references-count":52,"alternative-id":["10.3389\/fpubh.2023.1181880"],"URL":"https:\/\/doi.org\/10.3389\/fpubh.2023.1181880","relation":{},"ISSN":["2296-2565"],"issn-type":[{"value":"2296-2565","type":"electronic"}],"subject":[],"published":{"date-parts":[[2023,10,25]]},"article-number":"1181880"}}