Association Between Hemoglobin,Albumin,Lymphocyte,and Platelet Score and Diabetic Foot Ulcer: A Cross-Sectional Study

Abstract

Background

Diabetic foot ulcer (DFU) is a common and serious complication of diabetes mellitus, with high rates of disability and mortality. Early diagnosis and prevention can effectively reduce its incidence. The relationship between hemoglobin, albumin, lymphocyte count, and platelet (HALP) score, which are biomarkers reflecting the inflammatory and nutritional status of the body, and DFU has not been investigated. This study aimed to investigate the association between HALP score and DFU.

Methods

This cross-sectional study used data from the National Health and Nutrition Examination Survey (NHANES) from 1999 to 2004. Logistic regression models assessed the relationship between HALP scores (as both continuous and categorical variables) and DFU, adjusting for confounders. Restricted cubic spline (RCS) analysis was employed to evaluate potential non-linear relationships. Subgroup and sensitivity analyses were conducted to ensure the robustness of the findings.

Results

A total of 1604 participants (mean age: 61.67 ± 11.88 years; 52.9% male) were included. Multivariate logistic regression analysis, after adjusting for multiple confounders, revealed a negative correlation between the HALP score and DFU (OR = 0.98, 95% CI: 0.97–0.99, P = 0.041). This association remained significant when the HALP was categorized into quartiles. RCS analysis identified a non-linear relationship, with an inflection point at 44.98 (non-linear P = 0.017). Subgroup analyses confirmed the consistency of these findings across different demographic and clinical groups. Sensitivity analysis excluding extreme outliers confirmed the stability and reliability of the results.

Conclusion

Lower HALP scores are significantly associated with an increased risk of DFU. This study underscores the potential utility of the HALP score as a tool for identifying individuals at higher risk, supporting its use in the prevention and management of DFU.