Serum Albumin Levels as Predictors of Microvascular Health and Wound Healing Outcomes in Diabetic Foot Ulcers

Background: Diabetic foot ulcer (DFU) is a severe complication of diabetes mellitus (DM), affecting 15% of patients globally and contributing to 85% of non-traumatic lower extremity amputations. Albumin, a critical plasma protein, influences inflammation, vascularization, and tissue repair, and its deficiency (hypoalbuminemia) has been linked to poor DFU outcomes. This study aimed to investigate the association between serum albumin levels, microvascular density (MVD), and granulation tissue quality in DFU patients. Methods: A prospective observational study was conducted at Cipto Mangunkusumo General Hospital, Indonesia, from 2020 to 2022. Patients with DFU requiring surgical debridement or amputation were recruited. Baseline serum albumin levels were measured, and tissue samples were collected during procedures to evaluate granulation tissue and MVD via histological analysis. Statistical analyses, including Pearson/Spearman correlation, were performed to assess relationships between albumin levels, MVD, and granulation tissue. Results: Among 130 patients (50% male, mean age 57.66 ± 8.38 years), hypoalbuminemia was significantly associated with poorer DFU outcomes. Patients requiring amputation had lower serum albumin levels (median: 2.5 g/dL) than those undergoing debridement (median: 3.0 g/dL; p < 0.01). MVD was higher in the debridement group (median: 78.30 vessels/mm²) compared to the amputation group (median: 62.20 vessels/mm²; p = 0.02). Similarly, granulation tissue area was larger in the debridement group (median: 18.67%) than in the amputation group (median: 13.53%; p < 0.01). Strong positive correlations were observed between serum albumin levels and both MVD (R = 0.89, p < 0.01) and granulation tissue area (R = 0.89, p < 0.01). Conclusion: Serum albumin levels strongly correlate with MVD and granulation tissue quality, emphasizing its critical role in wound healing among DFU patients.