Abstract
PURPOSE: Diabetic foot ulcer (DFU) remains a major complication of diabetes mellitus and is a leading cause of non-traumatic lower extremity amputations. Biomarkers are used to predict disease prognosis and guide treatment decisions. This study aimed to evaluate the prognostic utility of three systemic inflammation and nutrition-based biomarkers HALP score, CRP/Albumin ratio, and CALLY index in predicting the major amputation risk among patients with DFU. METHODS: A retrospective analysis was conducted on 252 DFU patients who underwent surgical debridement and/or amputation between January 2018 and December 2023. Demographic, clinical, and laboratory data were collected. Patients were grouped based on surgical intervention (minor vs. major amputation). The HALP score, CRP/Albumin ratio, and CALLY index were calculated from admission laboratory values. Cut-off values were determined using ROC analysis. RESULTS: Major amputation was performed in 19% of the patients. The HALP score was significantly lower, while the CRP/Albumin ratio was higher, and the CALLY index was lower in the major amputation group (p < 0.001 for all). The optimal cut-off values to predict major amputation were 19.96 for HALP (AUC = 0.750), 2.29 for CRP/Albumin (AUC = 0.853), and 0.71 for CALLY (AUC = 0.830). All three markers demonstrated significant correlations with markers of infection, inflammation, and ulcer severity. CONCLUSION: The HALP score, CRP/Albumin ratio, and CALLY index are easily accessible prognostic tools that may assist clinicians in identifying DFU patients at higher risk for major amputation. Integration of these biomarkers into routine patient monitoring can improve risk assessment and guide timely surgical decision-making.