Diabetic foot ulcer carries high amputation and mortality rates, particularly in the presence of advanced age, peripheral artery disease and anemia

Costa, Rafael Henrique Rodrigues; Cardoso, Natália Anício; Procópio, Ricardo Jayme; Navarro, Túlio Pinho; Dardik, Alan; Cisneros, Lígia de Loiola

doi:10.1016/j.dsx.2017.04.008

Cited by 82 publications

(70 citation statements)

References 33 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…Peripheral arterial disease in DFUs has been reported to be associated with severe adverse outcomes, which include the lower probability of healing, prolonged healing times, increased incidence of ulcer recurrence, amputations, and higher mortality. 29,30 Presence of PAD may also be a pointer to atherosclerosis in other vessels including coronary vessels, which place such patients at higher risk of myocardial infarction and sudden cardiac deaths.…”

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. 2019

Preprint

View full text Add to dashboard Cite

Background/Objective : Diabetic foot ulcers (DFU) are associated with high morbidity and mortality globally. Mortality in patients hospitalized for DFU in Nigeria is unacceptably high. We sought to document contributory factors which predict mortality in patients hospitalized for DFU. Methods : Multi-centre Evaluation of Diabetic Foot Ulcer in Nigeria ( MEDFUN ), one-year 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. Co-morbid complications were documented. Results : Mean age 55.9 12.5 years.96.1% had type 2 diabetes (DM), mean duration of DM was 8.5 ± 5.7 years. Duration of ulcer was 39 days with a range of 28 to 54 days. 79.2% presented with at least grade 3 DFU. About one-fifth of the patients died (20.5%). Highest mortality among subjects with Wagner grade 5. Middle-aged subjects ( 45-64 years) had significantly higher mortality- odds ratio (OR) 5.107, Confidence interval (CI) of 1.429-18.252, and P-value 0.022. Variables significantly associated with mortality with the respective p- values are DM duration more than 120 months (0.008), ulcer duration > one month (0.013), ulcer severity of Wagner grade 3 and above (0.001), peripheral arterial disease (0.002), foot gangrene (< 0.001). Laboratory variables associated with mortality ; proteinuria (<0.001), positive blood cultures (<0.001), severe vascular stenosis (0.001), moderate vascular stenosis(< 0.001), Low HDL (< 0.001). Co-morbid complications significantly associated with mortality; shock at presentation (<0.001), anemia (0.034), cardiac failure (0.020), renal impairment (<0.001). Sepsis was the strongest predictor of mortality (adjusted OR 5.128; 95% CI 2.614 – 10.060) followed by renal impairment (adjusted OR 2.831; 95% C.I. for OR 1.346 – 5.953). Conclusions : Mortality among Nigerian diabetic patients admitted for DFU is high, univariate predictors of mortality: older age, higher Wagner grade (≥ 3) ulcer, longer duration of DM, longer duration of ulcer, peripheral arterial disease, foot gangrene, renal impairment, low HDL- cholesterol, anemia, shock, and cardiac failure. Renal impairment and positive blood culture were independent determinants of mortality.

show abstract

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. 2019

Preprint

View full text Add to dashboard Cite

show abstract

“…It is reported that every 30 s worldwide, there is a lower‐limb amputation as a direct result of DFU (Yazdanpanah et al ., ). This is undoubtedly accompanied by significant physical and emotional stress, as well as an increase in mortality rate (Costa et al ., ). In addition, there is an undeniable economic burden associated with the cost of health care, from disease management to major intervention (Walsh et al ., ).…”

Section: Significance Of Biofilms In Chronic Wound Infectionsmentioning

confidence: 97%

“…It is reported that every 30 s worldwide, there is a lower-limb amputation as a direct result of DFU (Yazdanpanah et al, 2015). This is undoubtedly accompanied by significant physical and emotional stress, as well as an increase in mortality rate (Costa et al, 2017).…”

Section: Significance Of Biofilms In Chronic Wound Infectionsmentioning

confidence: 99%

Ultrasound‐mediated therapies for the treatment of biofilms in chronic wounds: a review of present knowledge

LuTheryn

Glynne‐Jones

Webb

et al. 2019

Microbial Biotechnology

View full text Add to dashboard Cite

Summary Bacterial biofilms are an ever‐growing concern for public health, featuring both inherited genetic resistance and a conferred innate tolerance to traditional antibiotic therapies. Consequently, there is a growing interest in novel methods of drug delivery, in order to increase the efficacy of antimicrobial agents. One such method is the use of acoustically activated microbubbles, which undergo volumetric oscillations and collapse upon exposure to an ultrasound field. This facilitates physical perturbation of the biofilm and provides the means to control drug delivery both temporally and spatially. In line with current literature in this area, this review offers a rounded argument for why ultrasound‐responsive agents could be an integral part of advancing wound care. To achieve this, we will outline the development and clinical significance of biofilms in the context of chronic infections. We will then discuss current practices used in combating biofilms in chronic wounds and then critically evaluate the use of acoustically activated gas microbubbles as an emerging treatment modality. Moreover, we will introduce the novel concept of microbubbles carrying biologically active gases that may facilitate biofilm dispersal.

show abstract

“…Peripheral arterial disease in DFUs has been reported to be associated with severe adverse outcomes, which include the lower probability of healing, prolonged healing times, increased incidence of ulcer recurrence, amputations, and higher mortality. 32,33 Presence of PAD may also be a pointer to atherosclerosis in other vessels including coronary vessels, which place such patients at higher risk of myocardial infarction and sudden cardiac deaths.…”

Section: In 2009mentioning

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

View full text Add to dashboard Cite

Background/Objective: 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 is to document contributory factors that predict mortality in patients hospitalized for DFU in Nigeria. Methods: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. Co-morbid complications were documented.Results: Mean age 55.9 +/-12.5 years. 96.1% had type 2 diabetes (DM), the mean duration of DM was 8.5 ± 5.7 years. The duration of ulcers was 39 days with a range of 28 to 54 days. 79.2%presented with at least grade 3 DFU. About one-fifth of the patients died (20.5%). Highest mortality among subjects with Wagner grade 5. Middle-aged subjects (45-64 years) had significantly high mortality-odds ratio (OR) 5.107, Confidence interval (CI) of 1.429-18.252.Variables significantly associated with mortality with the respective p-values are DM duration more than 120 months (0.008), ulcer duration > one month (0.013), ulcer severity of Wagner grade 3 and above (0.001), peripheral arterial disease (0.002), foot gangrene (< 0.001). Laboratory variables associated with mortality; proteinuria (<0.001), positive blood cultures (<0.001), severe vascular stenosis (0.001), moderate vascular stenosis (< 0.001), Low HDL (< 0.001). Co-morbid complications significantly associated with mortality; shock at presentation (<0.001), anaemia (0.034), cardiac failure (0.020), renal impairment (<0.001). Sepsis was the strongest predictor of mortality (OR 5.128; 95% CI 2.614 -10.060) followed by renal impairment (OR 2.831; 95% CI 1.346 -5.953). Conclusions:Mortality among Nigerian diabetic patients admitted for DFU is high. The majority who died during hospitalization for DFU belong to the working-age population. Predictors of mortality were older age, higher Wagner grade (≥ 3) ulcer, longer duration of DM, longer duration of ulcer, peripheral arterial disease, foot gangrene, renal impairment, low HDL-cholesterol, anaemia, shock, and cardiac failure. Renal impairment and positive blood culture were independent determinants of mortality.

show abstract

Diabetic foot ulcer carries high amputation and mortality rates, particularly in the presence of advanced age, peripheral artery disease and anemia

Cited by 82 publications

References 33 publications

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

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

Ultrasound‐mediated therapies for the treatment of biofilms in chronic wounds: a review of present knowledge

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

Contact Info

Product

Resources

About