Association of high-density lipoprotein-related inflammatory indicators with diabetic foot ulcer in patients with diabetes: a population-based study
2025
Renhe Deng | Ruyi Tao | Huiyi Luo | Yueqi Gu | Mengyu Yang | Chaoqi Yin
Abstract Background Early identification and treatment of diabetic foot ulcer (DFU) in diabetes mellitus (DM) patients is of great importance for improving life quality. This study aimed to investigate the association between high-density lipoprotein (HDL)-related inflammatory indicators, such as neutrophils-to-HDL ratio (NHR), monocyte-to-HDL ratio (MHR), lymphocyte-to-HDL ratio (LHR), platelet-to-HDL ratio (PHR), and the occurrence of DFU in DM patients. Methods This study included 1211 DM patients from the National Health and Nutrition Examination Survey (1999–2004). The relationship between HDL-related inflammatory indicators and DFU was explored with logistic regression models. Using a threshold effects analysis model, the association and inflection points between HDL-related inflammatory indicators and diabetic foot ulcer were investigated. Subgroup analyses were performed to further confirm the relationship in different populations. Mediation analysis was conducted to examine how red blood cell mediates the relationship between HDL-related inflammatory indicators and DFU. Results After multivariable adjustment, there is a strongly positive relationship between NHR, MHR, PHR, and DFU, whereas no such associations were found between LHR and DFU. Threshold effect analysis showed an inflection point of 0.29 between MHR and DFU, with a 4.51-fold increase in the prevalence of DFU for each unit rise in MHR when MHR was more than the inflection point. Mediation analysis revealed that red blood cell partially mediates the association between NHR and DFU. Conclusions These findings reveal a clear association between NHR, MHR, PHR, and an increased prevalence of DFU, which can be used as potential biomarkers in the prevention and management of DFU.
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