Year: 2026
Type: article
Abstract: Background.Persistent vascular abnormalities after SARS-CoV-2 infection may complicate diabetic foot disease, but evidence linking endothelial assessment to wound outcomes remains limited.This study examined endothelial biomarker dynamics and clinical outcomes during implementation of a structured treatment pathway. Materials and methods.A single-centre cohort from Tashkent comprised 149 adults treated in 2021-2024.The principal comparison involved 46 patients with previous COVID-19 receiving conventional treatment in 2021-2022 and 53 receiving an assessment-guided pathway in 2023-2024.Fifty patients without documented previous COVID-19 provided a contextual reference.The pathway combined serial assessment, surgical source control, differentiated negative pressure wound therapy, vasoactive adjuncts and staged wound closure.Aggregate outcomes were analysed using unadjusted risk ratios and 95% confidence intervals (CIs).Results.The favourable composite of complete wound healing, independent walking without orthotic aids and no readmission within 30 days occurred in 42/53 patients (79.2%) receiving pathway care and 20/46 (43.5%) receiving conventional care.The risk ratio was 1.82 (95% CI 1.28-2.60),with an absolute difference of 35.8 percentage points (95% CI 16.7-51.7).Unsatisfactory outcomes occurred in 2/53 versus 11/46 patients.Recorded 12-month ulcer recurrence was 5/53 (9.4%) versus 15/46 (32.6%), giving a risk ratio of 0.29 (95% CI 0.11-0.73).Mean nitric oxide assay values increased from 19.1 to 27.4 μmol/L with pathway care and from 18.7 to 20.5 μmol/L with conventional care.Endothelin-1 and von Willebrand factor decreased more in the pathway cohort.Conclusion.Pathway implementation was associated with more favourable composite outcomes, fewer recorded recurrences and concordant endothelial biomarker changes.Historical controls, incomplete covariate data and uncertain assessment timing preclude causal attribution or validation of biomarkers as treatment targets.These findings support prospective evaluation of a standardized pathway with objective perfusion measurements and independently assessed clinical endpoints.
Author: Abdurakhmanov, Fayzirakhmon
Institution: Tashkent State Medical University
Language: English
Subfield: Endocrinology, Diabetes and Metabolism
Field: Medicine
Domain: Health Sciences
Open Access status: diamond
OpenAlex ID: W7217595767