Albuminuria is a predictive factor of in-hospital mortality in patients with diabetes admitted for foot disease

Aragón‐Sánchez, Javier; Lázaro‐Martínez, José Luis; García‐Álvarez, Yolanda; Morales, Esther García; Hernández-Herrero, María J.

doi:10.1016/j.diabres.2014.01.006

Cited by 16 publications

(17 citation statements)

References 12 publications

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“…Nephropathy has also been identified as a marker of generalized vascular involvement, so this complication is thought to be a predisposing factor to PAD in patients with diabetes . Different stages of nephropathy, including microalbuminuria and macroalbuminuria, have also been reported to play a role in the development of diabetic foot ulcers . Although nephropathy is important in the development of diabetic foot ulcers, this complication was not found in this meta‐analysis to be the cause of amputation in patients with DFI.…”

Section: Discussionmentioning

confidence: 76%

“…36 Different stages of nephropathy, including microalbuminuria and macroalbuminuria, have also been reported to play a role in the development of diabetic foot ulcers. 37 Although nephropathy is important in the development of diabetic foot ulcers, 8 ranging from 0 to 5. 38 Another classification system created by the IDSA and IWGDF expert consensus, graded diabetic foot ulcers in accordance with the severity of infection.…”

Section: Meta-analysis Of the Clinical Findingsmentioning

confidence: 99%

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Meta‐analysis of risk factors for amputation in diabetic foot infections

Şen

Demırdal

Emir

2019

Diabetes Metabolism Res

108

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Background Knowledge of risk factors is crucial to develop management and treatment protocols for the prevention of lower extremity amputation for patients with diabetic foot infections (DFIs). Methods We searched the research literature for studies reporting risk factors for lower extremity amputation in patients with DFI. The main outcome variables included both minor and major amputations. This study was reported in accordance with the Preferred Reporting Items for Systematic Reviews and Meta‐analyses (PRISMA) guidelines, and the protocol was registered in PROSPERO (CRD42018118543). Results A total of 2471 potential articles from the database search met the inclusion criteria. After reviewing the titles, abstracts, and full texts, remaining 25 articles were included in the final analysis. We identified 6132 patients with DFI in the 25 included articles. Of these, 1873 patients who underwent amputation were investigated. Male gender (odds ratio [OR]: 1.31), smoking (OR: 1.38), history of amputation (OR: 1.47), history of osteomyelitis (OR: 1.94), peripheral arterial disease (OR: 2.35), retinopathy (OR: 1.32), International Working Group on the Diabetic Foot (IWGDF) grades 3 and 4 (OR: 1.7 and 2.5), Wagner grades 4 and 5 (OR: 4.3 and 6.4), gangrene/necrosis (OR: 9.9), osteomyelitis (OR: 4.5), neuroischaemic DFI (OR: 3.06), severe infection (OR: 3.12), length of hospitalization (standardized mean difference [SMD]: 0.7), leukocytosis (OR: 1.76), mean erythrocyte sedimentation rate (ESR) (SMD: 0.5), mean C‐reactive protein (CRP) (SMD: 0.8), tissue culture positivity (OR: 1.61), and isolation of Gram‐negative bacteria from tissue culture (OR: 1.5) were found as predictors of amputation in DFI. Conclusions The present study highlighted some differences in diabetic foot ulcers and DFIs in terms of risk factors for lower extremity amputation. These data provide detailed information about risk factors for amputations among patients with DFI, thus contributing to the creation of new classification systems for assessment of high‐risk patients.

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Section: Discussionmentioning

confidence: 76%

Section: Meta-analysis Of the Clinical Findingsmentioning

confidence: 99%

Meta‐analysis of risk factors for amputation in diabetic foot infections

Şen

Demırdal

Emir

2019

Diabetes Metabolism Res

108

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“…34 Furthermore, Aragon-Sanchez et al reported albuminuria, anaemia, and leukocytosis as predictors of in-hospital mortality in patients admitted for DFU. 35 Positive blood culture is indicative of sepsis and the attendant systemic in ammatory response which carries a high risk of thromboses and organ dysfunction which have been associated with higher mortality in sufferers both generally and speci cally in those with DFUs. 36,37 Although diabetic patients with DFU have been observed to have a higher prevalence of cardiovascular risk factors such as hypercholesterolemia, hypertriglyceridemia, hyperuricemia, and proteinuria, 38 our observation of an association between mortality in hospitalized patients with DFU and low HDL cholesterol appears to be novel.…”

Section: Discussionmentioning

confidence: 99%

Predictors of intra-hospital mortality in patients with diabetic foot ulcers in Nigeria: data from the MEDFUN Study.

Adeleye

Ugwu

Gezawa

et al. 2020

Preprint

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Background: Diabetic foot ulcers (DFU) are associated with high morbidity and mortality globally. Mortality in patients hospitalized for DFU in Nigeria is unacceptably high. This study was undertaken to determine factors that predict mortality in patients hospitalized for DFU in Nigeria.Methods: The current study was part of Multi-centre Evaluation of Diabetic Foot Ulcer in Nigeria (MEDFUN), an observational study conducted in six tertiary healthcare institutions across the 6 geopolitical zones of Nigeria. Consecutive type 1 or 2 diabetic patients hospitalized for DFU who consented to participate were recruited and subjected to relevant clinical, biochemical, and radiological assessments and multidisciplinary care until discharge or death. Data for type 1 diabetes mellitus (DM) patients were expunged from current mortality analysis due to their small number.Results: Three hundred and twenty-three type 2 DM subjects with mean age and mean duration of DM of 57.2 11.4 years and 8.7± 5.8 years respectively participated in this study. The median duration of ulcers was 39 days with a range of 28 to 54 days and the majority (79.9%) presented with advanced ulcers of at least Wagner grade 3. Mortality of 21.4% was recorded in the study, with the highest mortality observed among subjects with Wagner grade 5. Variables significantly associated with mortality with their respective p values were DM duration more than 120 months (p 0.005), ulcer duration > one month (p 0.020), ulcer severity of Wagner grade 3 and above (p 0.001), peripheral arterial disease (p 0.005), proteinuria (p <0.001), positive blood cultures (p<0.001), low HDL (p <0.001), shock at presentation (p<0.001), cardiac failure (p 0.027),and renal impairment (p <0.001). On Multivariate regression analysis, presence of bacteraemia (OR 5.053; 95% CI 2.572-9.428) and renal impairment (OR 2.838; 95% CI 1.349 – 5.971) were significantly predictive of mortality independent of other variables.Conclusions: This study showed high intra-hospital mortality among patients with DFU, with the majority of deaths occurring among those with advanced ulcers, bacteraemia, cardiac failure, and renal impairment. Prompt attention to these factors might help improve survival from DFU in Nigeria.

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“…Recently, Aragón-Sánchez et al [23] reported that albuminuria was associated with in-hospital deaths of diabetic patients with foot complications. In the present cohort, over a median period of 6.6 years after discharge from hospital, the type 2 diabetic patients with albuminuria had a higher risk of all-cause and cardiovascular mortality than those without albuminuria detected during hospitalization.…”

Section: Discussionmentioning

confidence: 99%

Inpatient screening for albuminuria and retinopathy to predict long-term mortality in type 2 diabetic patients: a retrospective cohort study

Hsieh

Lee

Sheu

et al. 2017

Diabetol Metab Syndr

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BackgroundThere is a high hospitalization rate for diabetic patients. Since retinopathy and albuminuria are both important manifestations of microvascular disease in diabetes, our aim was to investigate the effect of retinopathy and albuminuria on long-term mortality in type 2 diabetic inpatients through this observational cohort study.MethodsType 2 diabetic inpatients given a primary diagnosis of poor glucose control were consecutively enrolled during their hospitalization periods. Clinical information was collected through review of each patient’s medical records, and mortality data were obtained from the national registry in Taiwan.ResultsA total of 761 type 2 diabetic inpatients were enrolled in the study with a median follow-up period of 6.6 years (interquartile range, 4.0–9.6 years). Patients in the Albuminuria(−)/Retinopathy(+), Albuminuria(+)/Retinopathy(−) and Albuminuria(+)/Retinopathy(+) groups had significantly higher risks of all-cause mortality and cardiovascular mortality than those in the Albuminuria(−)/Retinopathy(−) group. However, among patients with albuminuria, there was no significant difference in cumulative mortality between those with and without retinopathy (P = 0.821). A decrease in the estimated glomerular filtration rate (eGFR), but not retinopathy, was an independent predictor of all-cause mortality (95% CI 0.647‒0.893; P < 0.001) and cardiovascular mortality (95% CI 0.564‒0.921; P = 0.009) in type 2 diabetic inpatients with albuminuria.ConclusionsAlbuminuria in type 2 diabetic inpatients is a strong predictor of long-term mortality after discharge from the hospital. Retinopathy is an independent predictor of mortality in type 2 diabetic inpatients without albuminuria but not in those with albuminuria. A low eGFR is a better predictor of mortality than retinopathy in type 2 diabetic inpatients with albuminuria.

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Albuminuria is a predictive factor of in-hospital mortality in patients with diabetes admitted for foot disease

Cited by 16 publications

References 12 publications

Meta‐analysis of risk factors for amputation in diabetic foot infections

Meta‐analysis of risk factors for amputation in diabetic foot infections

Predictors of intra-hospital mortality in patients with diabetic foot ulcers in Nigeria: data from the MEDFUN Study.

Inpatient screening for albuminuria and retinopathy to predict long-term mortality in type 2 diabetic patients: a retrospective cohort study

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