The Prevalence of Anemia in Hospitalized Patients With Diabetic Foot Ulcer (DFU) and the Relationship Between the Severity of Anemia and the Severity of DFU

Background and aims: We aim to determine the prevalence of anemia in hospitalized patients with diabetic foot ulcers ( DFUs) and estimate the relationship between the severity of anemia and diabetic foot ulcer. Materials and methods: We retrospectively collected and evaluated the data of 323 patients hospitalized with diabetic foot ulcer (DFU). We included 299 type 2 diabetic patients with foot ulcers of neuropathic or neuroischemic nature with infection. Anemia was defined based on World Health Organization (WHO) criteria, and the severity of DFU was classified in University of Texas (UT) grades. Results: Anemia was detected in 94.3% of DFU, and the prevalence of mild, moderate, and severe anemia was 16.7%, 55.7%, and 27.6%, respectively. There was a significant difference in the mean hemoglobin (Hb) levels among the patients with varying grades of severity of DFU (1B: Hb=10.17 +/- 2.08 gm/dL, 2B: Hb=9.27 +/- 2.04 gm/dL, 3B: Hb=8.03 +/- 1.829 gm/dL; p value=<0.0001). The iron study was available in 141 (47.15%) patients and was suggestive of anemia of chronic disorder (mean serum iron=40.22 +/- 23.81 mcg/dL, mean total iron-binding capacity (TIBC)=239.34 +/- 67.24 mcg/dL, mean ferritin=378.05 +/- 141.337 ng/mL). TIBC significantly decreased (1B=262.13 +/- 61.05, 2B=233.65 +/- 71.26, 3B=222.43 +/- 74.18; p=0.04), and ferritin significantly increased (1B=309.9 +/- 70.76, 2B=351.73 +/- 94.22, 3B=488.58 +/- 170.4; p<0.0001) with increasing DFU severity. Hemoglobin was significantly decreased at the time of discharge in comparison to that at admission (9.3 +/- 2.1 gm/dL versus 8.8 +/- 1.5 gm/dL; p value=0.01). Red blood cell (RBC) counts, mean corpuscular volume (MCV), mean corpuscular hemoglobin concentration (MCHC), lymphocyte counts, albumin, calcium, and high-density lipoprotein (HDL) significantly decreased with the increase of DFU severity. The duration of hospitalization, total leucocyte counts, neutrophil counts, and neutrophil-to-lymphocyte ratio (NLR) increased with the severity of DFU. Conclusions: The prevalence of anemia was very high in DFU and more than three-fourths of the patients had moderate to severe anemia. The severity of anemia was associated with the severity of DFU. The most common cause of anemia was anemia of chronic disorder secondary to diabetic foot infection. During the period of hospitalization, hemoglobin decreased despite improvement in DFU infection.