Investigation of the Effectiveness of BAR, Shock Index and Early Warning Scores in the Prognosis of Patients with Diabetic Foot

Objective: Diabetic foot infections are severe complications of diabetes mellitus and are associated with substantial morbidity and mortality. This study aimed to eval-uate the prognostic performance of commonly used early warning scores, the shock index (SI), and the blood urea nitrogen-to-albumin ratio (BAR) in predicting clinical outcomes among patients with diabetic foot infections presenting to the emergency department (ED).
Material and Methods: This prospective study included adult patients presenting to the ED with diabetic foot infections. The predictive value of qSOFA, MEWS, NEWS2, REMS, TREWS, SI, and BAR was assessed for 28-, 90-, and 180-day mortality and amputation outcomes using receiver operating characteristic (ROC) curve analysis.
Results: A total of 92 patients were included. BAR demonstrated the highest prognostic accuracy for mortality at all time points (AUC: 0.802 at 28 days, 0.774 at 90 days, and 0.787 at 180 days). SI was the only parameter significantly associated with 28-day amputation risk (AUC: 0.636). None of the evaluated scores showed adequate predictive performance for 90- or 180-day amputation.
Conclusion: BAR appears to be a reliable marker of short- and medium-term mortality risk in patients with diabetic foot infections presenting to the ED, whereas SI may assist in the early identification of patients at increased risk for early amputation. These findings highlight the complementary roles of systemic and hemodynamic markers in the emergency risk stratification of diabetic foot infections.

Keywords: Amputation, diabetic foot, emergency department, mortality, shock index