The relationship between liver ultrasound elastography findings and vascular insufficiency and metabolic parameters in patients with diabetic foot ulcer diagnosis

ABSTRACT THE RELATIONSHIP BETWEEN LIVER ULTRASOUND ELASTOGRAPHY FINDINGS AND VASCULAR INSUFFICIENCY AND METABOLIC PARAMETERS IN PATIENTS WITH DIABETIC FOOT ULCER DIAGNOSIS Chronic hyperglycemia due to diabetes leads to long-term dysfunction and failure in multiple organs. This study aimed to evaluate the relationship between liver ultrasound elastography findings, arterial insufficiency, and metabolic parameters in patients diagnosed with diabetic foot ulcer (DFU). In addition, the study investigated ankle-brachial index (ABI) measurements, microvascular complications, and biochemical parameters in these patients. The study included three groups: a control group of 25 healthy individuals, 25 patients with DFU and arterial insufficiency DM + AI (+), and 25 patients with DFU without arterial insufficiency DM + AI (−). All participants underwent liver parenchymal stiffness measurements using two-dimensional shear wave elastography (2D-SWE), ABI assessment, and routine biochemical analyses. Microvascular complications (retinopathy, neuropathy, and nephropathy) and laboratory parameters were compared among the groups. Liver elastography values were significantly higher in DFU groups compared to controls, with the highest levels observed in the DM + AI (+) group. The proportion of ABI scores <1 was greater in DFU groups than in controls, particularly in the DM + AI (+) group. Microvascular complications were more frequent in the DM + AI (−) group compared to the DM + AI (+) group. Higher CRP, ESR, WBC, and platelet levels were observed in the DM + AI (+) group. Glomerular filtration rate (GFR) was reduced in all DFU patients, with the lowest levels in the DM + AI (+) group. Regarding lipid profile, total and LDL cholesterol levels were higher in the control group, while triglyceride and non-HDL lipid parameters were higher in DFU groups. In conclusion, liver parenchymal stiffness is more prominently increased in DFU patients with arterial insufficiency. ABI measurements more frequently show pathological values in patients with arterial insufficiency. The distribution of microvascular complications varies according to the presence of arterial insufficiency. These findings suggest that liver elastography and ABI assessment may provide additional value in evaluating vascular status in DFU patients. Keywords: Diabetic foot ulcer, arterial insufficiency, shear wave elastography, ABI, microvascular complications.