Prospective Comparative Evaluation of Wagner, Pedis, and Texas Classification Systems in Predicting Outcomes of Diabetic Foot Ulcers

İsmail Sezikli; Ramazan Topcu; Emre Demir; Murat Kendirci

doi:10.52827/hititmedj.1684061

Prospective Comparative Evaluation of Wagner, Pedis, and Texas Classification Systems in Predicting Outcomes of Diabetic Foot Ulcers

Authors : İsmail Sezikli, Ramazan Topcu, Emre Demir, Murat Kendirci

Pages : 358-368

Doi:10.52827/hititmedj.1684061

View : 80 | Download : 55

Publication Date : 2025-10-13

Article Type : Research Paper

Abstract :Objective: This study aims to compare the effectiveness of three classification systems—Wagner, PEDIS, and Texas—in predicting treatment outcomes and amputation risk in patients with diabetic foot ulcers (DFUs). Given the high morbidity and mortality associated with DFUs, accurate prognostic tools are essential for guiding management and reducing limb loss. Material and method: A total of 121 patients diagnosed with DFUs between 2018 and 2020 at Hitit University Faculty of Medicine were prospectively enrolled. Data collected included demographics, wound characteristics, ankle-brachial index (ABI), radiological findings, neuropathy status, and laboratory results. Patients were classified according to Wagner, PEDIS, and Texas systems. The relationship between classification results and clinical outcomes, such as healing and amputation, was analyzed using statistical methods, with significance set at p<0.05. Results: The PEDIS system with a cutoff value of 7.5 effectively distinguished between healing and amputation cases. Wagner grade 4 and above significantly predicted higher amputation risk (AUC=0.728; P<0.001). Patients with ABI <0.9 showed a 50.9% amputation rate, compared to 23.5% in those with ABI ≥0.9. The neutrophil-to-lymphocyte ratio correlated with infection and higher amputation risk. Male gender, advanced age, and elevated neutrophil-to-lymphocyte ratios increased the likelihood of limb loss. Conclusion: While PEDIS was more effective in differentiating healing from amputation, Wagner better predicted amputation risk. A lower ABI and high neutrophil-to-lymphocyte ratio were associated with worse outcomes. The study highlights the need for a comprehensive, universally applicable classification system that incorporates clinical and laboratory parameters to optimize patient management and reduce amputations.
Keywords : amputasyon, sınıflandırma, diyabetik ayak ülseri

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