The relationship between amputation level and blood hypoxia- inducible factor- 1alpha, fetuin- A, fibrinogen and homocysteine level in pati̇ents with diabeti̇c foot

Cause of increased survival in patient with diabetes mellitus, incidence of chronic complications in this patient group has increased. The diabetic foot syndrome, which is one of those important complications, occurs usually as a result of presence both of diabetic neuropathy and vascular failure and it's reason % 60 of nontraumatic lower extremity amputations. Also that's one of the most important public health problems everywhere in the world cause of its increased cost, mortality, morbidity and hospitalization time. Hypoxia- inducible factor- 1 alpha (HIF- 1α), plays a key role at developing adaptation response to hypoxia and it's expedites healing by arranging epithelium restoration and keratinocyte migration. In studies, HIF- 1α disfunction has shown in diabetic patients cause of faulty transactivation at hyperglycemic environment. Fetuin- A is a carrier protein that has produced from liver as albumine and inhibates of vascular and ectopic calcifications with its insulin activity. It has observed that lower fetuin- A levels is related with peripheral artery disease causing vascular calcification and upper fetuin- A levels is related with developing minimal inflammation and metabolic syndrome in diabetic patients. Fibrinogen is an acut phase reactant that's produced from liver and it has important functions in hemostasis, tissue repair amd wound healing. Increased blood fibrinogen level in diabetic patients is one of the factors that facilitates developing prothrombotic status. Homocysteine is an aminoacid that occurs during methionine metabolism and has atherogenic characteristic (related with endothelial disfunction; thrombocyte activation and thrombosis formation after injury), also it crauses vascular toxicity by increasing oxidation of LDL. As a result of this toxic effects, homocysteine can cause vascular disease by changing normal anticoagulant phenotype of endothelium. In our study, we investigated correlations between amputation level and biochemical criteria by measuring levels of blood HIF- 1alfa, fetuin- A, fibrinogen and homocysteine in 31 patients those have DM, diabetic foot wound, amputation decision was taken in Diabetic Foot Council As a result of our study, there was statistically negative correlation between blood fetuin- A level and amputation level (p: 0.012, r: -0.450). But there was no significant correlation between amputation level and other biochemical parameters, HIF- 1alfa, fibrinogen and homocysteine (p > 0.05). With these results, it has thought that vascular calcifications cause of decreased fetuin- A levels may be probably important role in diabetic foot pathogenesis. Also it has thinked that fetuin- A can be a marker that predicts amputation level. Based on this information, animal studies for pathogenesis and large- scale human studies that determines cutoff level of fetuin- A can be do. Keywords: Diabetic foot, amputation, HIF- 1α, Fetuin- A, Fibrinogen, Homocysteine.