The Relationship Between Asymmetric Dimethylarginine and Ankle-Brachial Index With the Severity of Diabetic Foot Ulcers

ABSTRACT   Introduction: Approximately 50% of inpatient cases for diabetic complications are diabetic foot ulcers (DFU). Peripheral artery defect is one of the mechanisms that is characterized by increased asymmetric dimethylarginine (ADMA). Severe diabetic foot ulcers are found in populations with low ankle-brachial index (ABI) values. This study aims to find the relationship between ADMA and ABI in predicting risk for DFU. Methods: An Observational study with a cross-sectional method was conducted at Adam Malik Hospital, Medan collaboration with the Clinical Laboratory from the Faculty of Medicine, Universitas Sumatera Utara. Forty-two patients with DFU from September 2023 to April 2024 were registered with the following information: anthropometric, gender, history of drug use, comorbidities, ABI, ADMA, complete blood count, lipid profile, and fasting blood glucose. Results: In grade II DFU, the average ADMA value was 87.6 ng/dl, grade III 231.3 ng/dl, grade IV 444.9 ng/dl, and grade V 652.3 ng/dl. ABI value using Sokoye classification shows grade II DFU has an average ABI value of 1.08 (Normal), grade III 0.74 (Mild), Grade IV 0.61 (Moderate), and grade V 0.5 (Moderate). There is a significant relationship between the severity of DFU (Wagner scale) and ADMA levels (P = 0.001) and  ABI values ​​(P = 0.001). There is a relationship between ADMA and ABI values with DFU (P = 0.001). Conclusion: There is a significant relationship between the severity of DFU (Wagner scale) and ADMA levels (P = 0.001) and  ABI values ​​(P = 0.001). There is a relationship between ADMA and ABI values with DFU (P = 0.001). Keywords: Diabetic foot ulcer, Asymmetric dimethylarginine, Ankle-brachial index       ABSTRAK   Pendahuluan: Sekitar 50% kasus rawat inap untuk komplikasi diabetes adalah diabetic foot ulcers (DFU). Cacat arteri perifer adalah salah satu mekanisme yang ditandai dengan peningkatan asymmetric dimethylarginine (ADMA). Ulkus kaki diabetes parah ditemukan pada populasi dengan ankle-brachial index (ABI) values. Penelitian ini bertujuan untuk mengetahui hubungan antara ADMA dan ABI dalam memprediksi risiko untuk DFU. Metode: Studi Observasional dengan metode cross-sectional dilakukan di Rumah Sakit Adam Malik Medan bekerja sama dengan Laboratorium Klinik dari Fakultas Kedokteran, Universitas Sumatera Utara. Empat puluh dua pasien DFU dari September 2023 hingga April 2024 terdaftar dengan informasi dari antropometri, jenis kelamin, riwayat penggunaan narkoba, komorbiditas, ABI, ADMA, hitung darah lengkap, profil lipid, dan glukosa darah puasa sebagai berikut.. Hasil: Nilai ADMA rata-rata DFU kelas II: 87,6 ng/dl, grade III: 231,3 ng/dl, grade IV: 444,9 ng/dl, dan grade V: 652,3 ng/dl. Nilai ABI menggunakan klasifikasi Sokoye menunjukkan DFU grade II memiliki nilai ABI rata-rata 1,08 (Normal), grade III 0,74 (Mild), Grade IV 0,61 (Moderate), dan grade V 0,5 (Moderate). Terdapat hubungan antara tingkat keparahan DFU (skala Wagner) dengan kadar ADMA (P = 0,001) dan nilai ABI (P = 0,001). Ada hubungan antara nilai ADMA dan ABI dengan DFU (P = 0,001). Kesimpulan: Ada hubungan antara tingkat keparahan DFU (skala Wagner) dengan kadar ADMA (P = 0,001) dan nilai ABI (P = 0,001). Ada hubungan antara nilai ADMA dan ABI dengan DFU (P = 0,001). Kata kunci: Ulkus kaki diabetik, Asimetris Dimetilarginin, ABI