Is There an Association between Amputation Risk and Nutritional Status in Diabetic Foot Syndrome?

Abstract

Purpose

Diabetic foot syndrome (DFS) occurs in 15–25% of diabetic patients. Identification of risk factors for malnutrition and prevention is valuable for patients with DFS. The aim of this study was to investigate the association between blood parameters and nutritional indices obtained from simple blood parameters and diabetic foot amputations.

Methods

A single-center cross-sectional observational study was conducted between March 2024 and March 2025. According to whether they underwent amputation, including amputations of minor and major lower extremities, patients were divided into two groups: amputated (Group A) and non-amputated (Group NA). Patients older than 18 years with a DFD diagnosis were included. Data was analyzed statistically.

Results

A total of 237 DFS patients were included in the study, with 92 patients in Group A and 145 patients in Group NA. CRP/albumin ratio (p < 0.001), albumin/globulin ratio (p = 0.003), PNI (p < 0.001), and CONUT score (p < 0.001) results revealed statistically significant differences between groups. CONUT score demonstrated significant associations in univariate and multivariate analyses. Patients with a CONUT score ≥ 5 had a 2.28 times higher risk of amputation compared to patients with a CONUT score < 5.

Conclusion

Our results showed significant correlations between CONUT score and amputation as well as a significant association between both CONUT scores and CONUT severity, and diabetic foot amputations. This study also demonstrates that the CONUT score is a significant predictor of amputation risk in patients with diabetic foot disease, with those having a CONUT score ≥ 5 showing a 2.28-fold increased risk of amputation.

Zusammenfasssung

Einleitung

15–25% der Diabetiker leiden an diabetischem Fußsyndrom (DFS). Die Identifizierung von Risikofaktoren für Mangelernährung und deren Prävention sind für Patienten mit DFS wertvoll. Ziel dieser Studie war es, den Zusammenhang zwischen Blutparametern und Ernährungsindizes, die aus einfachen Blutparametern gewonnen wurden, und diabetischen Fußamputationen zu untersuchen.

Methoden

Zwischen März 2024 und März 2025 wurde eine monozentrische Querschnittsbeobachtungsstudie durchgeführt. Die Patienten wurden unter Berücksichtigung des Auftretens von Amputationen, einschl. kleinerer und größerer Amputationen der unteren Extremitäten, in 2 Gruppen eingeteilt: amputiert (Gruppe A) und nicht amputiert (Gruppe NA). Patienten über 18 Jahre mit einer DFD-Diagnose wurden eingeschlossen. Die Daten wurden statistisch ausgewertet.

Ergebnisse

Insgesamt wurden 237 DFD-Patienten in die Studie aufgenommen, davon 92 Patienten der Gruppe A und 145 Patienten der Gruppe NA. Die Ergebnisse des CRP-Albumin-Verhältnisses (p < 0,001), des Albumin-Globulin-Verhältnisses (p = 0,003), des PNI (p < 0,001) und des CONUT-Scores (p < 0,001) zeigten statistisch signifikante Unterschiede zwischen den Gruppen. Der CONUT-Score zeigte signifikante Assoziationen in univariaten und multivariaten Analysen. Patienten mit einem CONUT-Score ≥ 5 hatten ein 2,28-mal höheres Amputationsrisiko als Patienten mit einem CONUT-Score < 5.

Schlussfolgerung

Unsere Ergebnisse zeigten signifikante Korrelationen zwischen dem CONUT-Score und der Amputation sowie einen signifikanten Zusammenhang zwischen den CONUT-Scores und dem CONUT-Schweregrad sowie diabetischen Fußamputationen. Darüber hinaus zeigt diese Studie, dass der CONUT-Score ein signifikanter Prädiktor des Amputationsrisikos bei Patienten mit diabetischem Fußsyndrom ist, wobei Patienten mit einem CONUT-Score ≥ 5 ein 2,28-fach erhöhtes Amputationsrisiko aufweisen.

Keywords

prognostic nutritional index - controlling nutritional status score - albumin-globulin ratio - amputation risk - diabetic foot syndrome

Schlüsselwörter

prognostischer Ernährungsindex - kontrollierender Ernährungszustand - Albumin-Globulin-Verhältnis - Amputationsrisiko - diabetisches Fußsyndrom

Publication History

Received: 14 August 2025

Accepted after revision: 02 December 2025

Article published online:
20 January 2026

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