Predictors of amputation in diabetics with foot ulcer: Single center experience in a large Turkish cohort (original) (raw)
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Factors Affecting Amputations in Patients with Diabetic Foot Ulcer Referring To the Emergency Units
Dicle Tıp Dergisi, 2017
Objective: Diabetic foot is the most common cause of lower extremity amputations. The aim of the present study was to investigate the clinical characteristics of and factors affecting amputation in patients with diabetic foot ulcer referring to the emergency units. Methods: The present study was performed based on retrospective review of medical files of 58 patients who were referred to the Emergency Unit of Dicle University, Faculty of Medicine between June 2010 and October 2016 due to diabetic foot ulcer. Results: Of 58 patients included in this study, 31 (53.4%) were men and 27 (46.6%) were women. The mean age was 61.43±11.584 (range: 41 to 85) years. Extremity amputation was not performed in 34 patients (58.6%), while 24 (41.4%) underwent an amputation. Factors affecting extremity amputation were found to be disease duration, presence of coronary artery disease, duration of hospital stay, and presence of osteomyelitis. Among laboratory findings, factors affecting extremity amputation were albumin, hemoglobin, leukocytes, neutrophil, neutrophil/lymphocyte ratio, hemoglobin A1c, and elevated erythrocyte sedimentation rate. The Wagner-Meggitt Classification of Grade 4, University of Texas Classification of stage D and Grade 3 also had significant effects on amputation. (p<0.05) Conclusion: Our study results suggest that together with classification systems, comorbidities, albumin levels, hemoglobin A1c levels, sedimentation rate, and complete blood count results play a key role in predicting the amputation requirement in patients with diabetic foot ulcers referring to the emergency units.
JPMA. The Journal of the Pakistan Medical Association, 2021
OBJECTIVE To assess the risk factors for lower limb amputations in diabetic patients presenting with foot ulcers. Methods The analytical cross-sectional study was conducted at the Mayo Hospital, Lahore, Pakistan, from December 1, 2019, to May 31, 2020, and comprised patients of either gender having type 1 or type 2 diabetes and foot ulcers. The wounds were assessed according to Wagner wound staging and wound sepsis was evaluated in terms of local infection of the wound, leucocytosis and osteomyelitis of the bone. The glycaemic control of these patients was assessed on presentation by measuring glycated haemoglobin levels. Data was analysed using SPSS 26. RESULTS Of the 135 patients, 82(60.7%) were males and 53(39.2%) were females. Majority patients 59(43.7%) were aged 50-60 years. All 135(100%) patients underwent some type of amputation. Of all the amputations, 91(67.4%) were done in patients with poor glycaemic control on presentation, and 56(41.5%) in those with stage 4 wound. Loc...
Wiener klinische Wochenschrift, 2014
Background Diabetic foot infections are associated with substantial morbidity and mortality. Prediction of diabetic foot ulcer outcome may be helpful for optimizing management strategy. This study aimed to determine the major predictors of amputation and length of stay in diabetic patients with acute foot ulceration. Methods A total of 55 type 2 diabetic patients with diabetic foot infection were enrolled. The patients were evaluated according to the Infectious Diseases Society of America and International Working Group on the Diabetic Foot criteria and also the Wagner's classification. Blood samples were taken at the start of hospitalization for the measurement of glucose, hemoglobin A1C (HbA 1 C), white blood cells (WBC), C-reactive protein (CRP), and erythrocyte sedimentation rate (ESR). Length of stay in hospital was recorded. Results WBC and CRP were significantly higher in lower-extremity amputation (LEA) group (p = 0.001 and p = 0.008, respectively); also, ESR was higher in this group, but there was no statistical significance. Wagner grade and infection severity were significantly higher in the LEA group as compared with the non-LEA group (both p values < 0.001). Glycemic control parameters (i.e., HbA 1 C, plasma glucose) were not different in LEA and non-LEA groups. In correlation analyses, amputation rate was negatively correlated (r = − 0.512, p < 0.
Predictors of Lower-Extremity Amputation in Patients With an Infected Diabetic Foot Ulcer
Diabetes Care, 2015
Infection commonly complicates diabetic foot ulcers and is associated with a poor outcome. In a cohort of individuals with an infected diabetic foot ulcer, we aimed to determine independent predictors of lower-extremity amputation and the predictive value for amputation of the International Working Group on the Diabetic Foot (IWGDF) classification system and to develop a risk score for predicting amputation.
The independent contribution of diabetic foot ulcer on lower extremity amputation and mortality risk
Journal of Diabetes and its Complications, 2014
Aims: To estimate 3-year risk for diabetic foot ulcer (DFU), lower extremity amputation (LEA) and death; determine predictive variables and assess derived models accuracy. Material and Methods: Retrospective cohort study including all subjects with diabetes enrolled in our diabetic foot outpatient clinic from beginning 2002 until middle 2010. Data was collected from clinical records. Results: 644 subjects with mean age of 65.1 (±11.2) and diabetes duration of 16.1 (±10.8) years. Cumulative incidence was 26.6% for DFU, 5.8% for LEA and 14.0% for death. In multivariate analysis, physical impairment, peripheral arterial disease complication history, complication count and previous DFU were associated with DFU; complication count, foot pulses and previous DFU with LEA and age, complication count and previous DFU with death. Predictive models' areas under the ROC curves ranged from 0.80 to 0.83. A simplified model including previous DFU and complication count presented high accuracy. Previous DFU was associated with all outcomes, even when adjusted for complication count, in addition to more complex models. Conclusions: DFU seems more than a marker of complication status, having independent impact on LEA and mortality risk. Proposed models may be applicable in healthcare settings to identify patients at higher risk of DFU, LEA and death.
Diabetology & Metabolic Syndrome, 2016
Background: Studies on diabetic foot and its complications involving a significant and representative sample of patients in South American countries are scarce. The main objective of this study was to acquire clinical and epidemiological data on a large cohort of diabetic patients from 19 centers from Brazil and focus on factors that could be associated with the risk of ulcer and amputation. Methods: This study presents cross sectional, baseline results of the BRAZUPA Study. A total of 1455 patients were included. Parameters recorded included age, gender, ethnicity, diabetes and comorbidity-related records, previous ulcer or amputation, clinical symptomatic score, foot classification and microvascular complications. Results: Patients with ulcer had longer disease duration (17.2 ± 9.9 vs. 13.2 ± 9.4 years; p < 0.001), and poorer glycemic control (HbA1c 9.23 ± 2.03 vs. 8.35 ± 1.99; p < 0.001). Independent risk factors for ulcer were male gender (OR 1.71; 95 % CI 1.2-3.7), smoking (OR 1.78; 95 % CI 1.09-2.89), neuroischemic foot (OR 20.34; 95 % CI 9.31-44.38), region of origin (higher risk for those from developed regions, OR 2.39; 95 % CI 1.47-3.87), presence of retinopathy (OR 1.68; 95 % CI 1.08-2.62) and absence of vibratory sensation (OR 7.95; 95 % CI 4.65-13.59). Risk factors for amputation were male gender (OR 2.12; 95 % CI 1.2-3.73), type 2 diabetes (OR 3.33; 95 % CI 1.01-11.1), foot at risk classification (higher risk for ischemic foot, OR 19.63; 95 % CI 3.43-112.5), hypertension (lower risk, OR 0.3; 95 % CI 0.14-0.63), region of origin (South/Southeast, OR 2.2; 95 % CI 1.1-4.42), previous history of ulcer (OR 9.66; 95 % CI 4.67-19.98) and altered vibratory sensation (OR 3.46; 95 % CI 1.64-7.33). There was no association between either outcome and ethnicity. Conclusions: Ulcer and amputation rates were high. Age at presentation was low and patients with ulcer presented a higher prevalence of neuropathy compared to ischemic foot at risk. Ischemic disease was more associated with amputations. Ethnical differences were not of great importance in a miscegenated population.
Risk Factors for Lower Extremity Amputation in Diabetic Foot Ulcer Patients: A Case-Control Study
JUXTA: Jurnal Ilmiah Mahasiswa Kedokteran Universitas Airlangga
Introduction: Diabetes mellitus is a metabolic syndrome that is marked by higher blood glucose. The uncontrolled high blood glucose can lead to complication, such as diabetic foot. Diabetic foot is the most reason why diabetic patients are hospitalized. Diabetic foot that cannot heal may lead to lower extremity amputation. The purpose of this study was to describe the risk factors of lower extremity amputation in diabetic foot ulcer patients.Methods: This study used a case-control study of diabetic foot patients in Dr. Soetomo General Hospital from January 2015 to December 2017. This study used the data from medical records in Inpatient Installation Department of Internal Medicine. Patients with diabetic foot ulcer and lower extremity amputation due to diabetes were included in this study. Incomplete medical records were excluded. Data of samples were divided to two groups, i.e. the amputation group and the non-amputation group with a ratio of 1:1. Risk factors of amputation that we...
Indonesian Journal of Medicine, 2020
Background: Diabetic foot ulcer is a complication of diabetes mellitus which costs high, takes long wound care, increases mortality, morbidity and causes non-traumatic amputation. There are risk factors that are thought to be the cause of lower limb amputation in diabetic foot ulcers, namely peripheral artery disease, hypertension and gender. This study aims to estimate the influence of peripheral artery disease, hypertension and gender on the risk of lower limb amputation in diabetes mellitus patients with leg ulcers. Subjects and Method: Meta-analysis studies and systematic reviews were applied to this study using electronic databases of Pubmed, Scopus, Google Scholar, and Springer Link. The keywords to search for articles are as follows: "diabetic foot", "lower limb amputation", "lower extremity amputation", "risk factor", "predictor", "cohort", "retrospective", "adjusted odds ratio". Articles were collected using PRISMA diagrams, and analyzed using the Review Manager 5.3 application. Results: Meta-analysis of 9 cohort articles of diabetic foot ulcer patients with peripheral artery disease (aOR= 2.46; 95% CI= 1.70-3.55; p<0.01); Meta-analysis of 8 cohort articles, diabetic foot ulcer patients with hypertension (aOR= 1.05; 95% CI= 0.66-1.68; p= 0.83); Meta-analysis of 9 cohort articles of male diabetic foot ulcer patients (aOR= 1.60; 95% CI= 1.32-1.94; p<0.01); Peripheral artery disease, hypertension and male gender are risk factors that can increase the incidence of lower limb amputation. Conclusion: Peripheral artery disease, hypertension and male gender are risk factors that can increase the incidence of lower limb amputation.
Evaluating a Risk Score for Lower Extremity Amputation in Patients with Diabetic Foot Infections
JOURNAL OF CLINICAL AND DIAGNOSTIC RESEARCH, 2018
Introduction: Factors associated with Diabetes Mellitus (DM) patients developing a foot ulcer are well defined, but risk factors for amputation are less clear. There are substantial morbidity and mortality associated with Lower Extremity Amputation (LEA) in patients with DM. The ability to identify which patients hospitalised for diabetic foot are at highest risk of LEA, could help clinicians to direct patients for special preventive efforts. Aim: To develop a scoring system to predict the risk of LEA in patients with a diabetic foot ulcer. Materials and Methods: One hundred and fifty patients with infected diabetic foot ulcer were included for this prospective, observational study. Score was allotted to following variables: age, sensory neuropathy, motor neuropathy, deformity, Infectious Diseases Society of America (IDSA) infection grade, past H/O amputation, ulcer depth grade, duration of DM, HbA1c, Rutherford grading and ankle brachial index. Total score of each subject was calculated after adding scores of risk factors. Statistical significance of categorical variables was tested using chi-square test or Fisher's-Exact test. Threshold cutoff of total risk score for predicting incidence of amputation was determined using Receiver Operating Characteristics (ROC) curve analysis. Measures of diagnostic efficacy indices such as sensitivity, specificity, positive predictive value, negative predictive value and accuracy were calculated. Results: Patients with score of >16.5 were at increased risk of LEA and risk of amputation increased as the score increased. Percentage of patients who required amputation was significantly high in >65 years of age, duration of DM >20 years, sensory neuropathy Grade 2, presence of motor neuropathy, presence of deformity, IDSA infection Grade IV, past H/O amputation, ulcer depth Grade IV, HbA1c ≥12.5% (113.5 mmol/ mol), ankle brachial index ≤0.9 or ≥1.30, and Rutherford Grading IV. Multivariate analysis revealed that duration of DM, HbA1c, Rutherford grading and ankle brachial index were significantly associated with LEA. Conclusion: The score will help clinicians to identify patients at high risk of LEA on examination.
Risk Factors for Lower Extremity Amputation in Patients with Diabetic Foot Ulcers
Background: The number patients with diabetic foot ulcers presenting to surgery clinics has been increasing at an alarming rate. Diabetic foot ulcers are the most common cause for nontraumatic foot amputation. This study was undertaken to analyze both the risk factors for development of foot ulcers in diabetics and for lower extremity amputation (LEA) in patients with diabetic foot ulcers. Methods: A prospective analytical study that assessed the various risk factors associated with the development of foot ulcers in diabetics and that eventually lead to LEA in these patients. Univariate analysis and multivariate logistic regression (WALD‘s TEST) were used to assess statistical significance. Results: A total of 120 patients were included in the study, of which 53 underwent LEA. The incidence of foot ulcers was found to be higher in the following categories: males, 5th decade, associated hypertension, hyperlipidemia, and duration of diabetes more than 5 years. The significant risk fac...