A meta‐analysis of the relationship between foot local characteristics and major lower extremity amputation in diabetic foot patients

Wang, Ning; Yang, Baoxue; Wang, Gang; Gao, Yu; Cao, Xin; Zhang, Xiaofu; Yan, Chengcheng; Lian, Xiaotong; Liu, Bo-Hong; Ju, Shang

doi:10.1002/jcb.28183

Cited by 22 publications

(22 citation statements)

References 44 publications

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“…Similar to what other studies have observed, we found a significant association between a lower chance of healing and HbA 1c > 7% [17]. Like other studies, our results show a bigger risk of amputation related to infection, smoking 20 cigarettes/day in >20 years, and HbA 1c > 7% [18–21].…”

Section: Resultssupporting

confidence: 91%

Healing of Diabetic Foot Ulcers in Patients Treated at the Copenhagen Wound Healing Center in 1999/2000 and in 2011/2012

Sørensen

Jansen

Fabricius

et al. 2019

Journal of Diabetes Research

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Aim. To describe differences in healing time of diabetic foot ulcers for patients treated at the Copenhagen Wound Healing Center, Bispebjerg Hospital, between the years 1999/2000 and 2011/2012. The Center is highly specialized and receives diabetes patients with hard-to-heal foot ulcers. A further aim is to attempt to find predictors of healing time of diabetic foot ulcers. Methods. A retrospective descriptive study of records from patients with diabetic foot ulcer treated at the Copenhagen Wound Healing Center in 1999, 2000, 2011, or 2012. Follow-up data was collected until the 3rd of August 2018. Results. Median time (range) to healing was 6 (61.3) months in 1999/2000 and 6.6 (67.8) in 2011/2012 (p=0.2). About 33% of ulcers were healed, 17% were minor or major amputated, and 1.5% were dead within one year in 1999/2000, whereas 30% of ulcers were healed (p=0.6), 14% were amputated (p=0.2), and 12.8% were dead within one year in 2011/2012 (p<0.001). The single factor found significantly associated with longer ulcer duration was infection. Related to shorter ulcer duration were toe localization of the ulcer and good glycemic control. Conclusion. The median time to healing of a diabetic foot ulcer was long, around 6 months and with a high recurrence rate in 1999/2000 as well as in 2011/2012. Some factors were found to be significantly related to healing time, and intervention addressing these may improve the time to heal, although such interpretations must be taken with precaution from the present study and should be proven in randomized prospective intervention trials.

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Section: Resultssupporting

confidence: 91%

Healing of Diabetic Foot Ulcers in Patients Treated at the Copenhagen Wound Healing Center in 1999/2000 and in 2011/2012

Sørensen

Jansen

Fabricius

et al. 2019

Journal of Diabetes Research

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“…Results of further analysis illustrated that, compared with T2DM patients suffering from DFU alone, T2DM patients suffering from both DFU and DFO had longer course of DM and DFU, higher Wagner grade of DFU, worse blood glucose control and lower extremity blood supply, and severer gradient of infection. According to the multivariate regression analysis results, the course of DFU, HbA1c, ABI, WBC count, and ESR were all independent influencing factors of the occurrence of DFU complicated with DFO, which was consistent with the findings of previous studies 43‐46 . Furthermore, compared with patients in the non‐DFO group, the miR‐24 level was significantly decreased in peripheral blood in patients in the DFO group.…”

Section: Discussionsupporting

confidence: 88%

Decreased expression of miR‐24 in peripheral plasma of type 2 diabetes mellitus patients associated with diabetic foot ulcer

Tang

Jia

et al. 2020

Wound Repair Regeneration

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To examine the correlations of miR‐24 expression in peripheral plasma with the onset of diabetic foot ulcer (DFU) and diabetic foot osteomyelitis (DFO) in type 2 diabetes mellitus (T2DM) patients and explore the clinical value of miR‐24 as a potential biomarker for the diagnosis and treatment outcomes of DFU and DFO, a total of 60 newly diagnosed T2DM patients without DFU (T2DM group), 112 T2DM patients with DFU (DFU group), and 60 healthy controls (NC group) were included. DFU group were further divided into DFO group (n = 64) and non‐DFO group (n = 48). MiR‐24 levels were determined by quantitative real‐time PCR, while clinical features and risk factors of DFU and DFO were explored. The expression level of miR‐24 in T2DM and DFU group was significantly lower than in NC group (P < .05), and that in DFU group was significantly lower than in T2DM group (P < .01). Additionally, the level of miR‐24 significantly decreased in DFO group compared to non‐DFO group (P < .01). Moreover, it was negatively correlated with the amputation rate in DFU group (P = .043) and positively correlated with healing rate after 8 weeks (P = .036). The multivariate logistic regression analysis confirmed that a low expression of miR‐24 was an independent risk factor for DFU and DFO. The ROC curve analysis indicated that the AUC of miR‐24 for the diagnosis of DFU and DFO was 0.849 (95% CI, 0.618‐0.879, P < .001) and 0.782 (95% CI, 0.595‐0.813, P < .001). Thus, a decreased expression of miR‐24 of T2DM patients was closely related to the occurrence, development and prognosis of DFU and DFO, suggesting the use of miR‐24 as a potential biomarker for the prediction of DFU and DFO.

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“…Good blood circulation ensures the absorption of sufficient nutrients and the carrier of immune cells to play a role to prevent the infection of microorganisms. As a significant risk factor for the occurrence and adverse clinical outcomes of DFU, PAD produced harmful effects on wound healing to some extend and then leaded to amputation and eventually increased mortality rates if not timely treated [ 14 ]. Previous study has found that a 2.64 times increased risk of amputation in patients with PAD [ 20 ].…”

Section: Discussionmentioning

confidence: 99%

Development of Predictive Nomograms for Clinical Use to Quantify the Risk of Amputation in Patients with Diabetic Foot Ulcer

Peng

Min

Liao

et al. 2021

Journal of Diabetes Research

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Objective. To determine the novel proposed nomogram model accuracy in the prediction of the lower-extremity amputations (LEA) risk in diabetic foot ulcer (DFU). Methods and Materials. In this retrospective study, data of 125 patients with diabetic foot ulcer who met the research criteria in Zhongnan Hospital of Wuhan University from January 2015 to December 2019 were collected by filling in the clinical investigation case report form. Firstly, univariate analysis was used to find the primary predictive factors of amputation in patients with diabetic foot ulcer. Secondly, single factor and multiple factor logistic regression analysis were employed to screen the independent influencing factors of amputation introducing the primary predictive factors selected from the univariate analysis. Thirdly, the independent influencing factors were applied to build a prediction model of amputation risk in patients with diabetic foot ulcer by using R4.3; then, the nomogram was established according to the selected variables visually. Finally, the performance of the prediction model was evaluated and verified by receiver working characteristic (ROC) curve, corrected calibration curve, and clinical decision curve. Results. 7 primary predictive factors were selected by univariate analysis from 21 variables, including the course of diabetes, peripheral angiopathy of diabetic (PAD), glycosylated hemoglobin A1c (HbA1c), white blood cells (WBC), albumin (ALB), blood uric acid (BUA), and fibrinogen (FIB); single factor logistic regression analysis showed that albumin was a protective factor for amputation in patients with diabetic foot ulcer, and the other six factors were risk factors. Multivariate logical regression analysis illustrated that only five factors (the course of diabetes, PAD, HbA1c, WBC, and FIB) were independent risk factors for amputation in patients with diabetic foot ulcer. According to the area under curve (AUC) of ROC was 0.876 and corrected calibration curve of the nomogram displayed good fitting ability, the model established by these 5 independent risk factors exhibited good ability to predict the risk of amputation. The decision analysis curve (DCA) indicated that the nomogram model was more practical and accurate when the risk threshold was between 6% and 91%. Conclusion. Our novel proposed nomogram showed that the course of diabetes, PAD, HbA1c, WBC, and FIB are the independent risk factors of amputation in patients with DFU. This prediction model was well developed and behaved a great accurate value for LEA so as to provide a useful tool for screening LEA risk and preventing DFU from developing into amputation.

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A meta‐analysis of the relationship between foot local characteristics and major lower extremity amputation in diabetic foot patients

Cited by 22 publications

References 44 publications

Healing of Diabetic Foot Ulcers in Patients Treated at the Copenhagen Wound Healing Center in 1999/2000 and in 2011/2012

Healing of Diabetic Foot Ulcers in Patients Treated at the Copenhagen Wound Healing Center in 1999/2000 and in 2011/2012

Decreased expression of miR‐24 in peripheral plasma of type 2 diabetes mellitus patients associated with diabetic foot ulcer

Development of Predictive Nomograms for Clinical Use to Quantify the Risk of Amputation in Patients with Diabetic Foot Ulcer

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