Mortality in Patients with Diabetic Foot Ulcers: Causes, Risk Factors, and Their Association with Evolution and Severity of Ulcer

Abstract

Background: This study reviews the mortality of patients with diabetic foot ulcers (DFU) from the first consultation with a Multidisciplinary Diabetic Foot Team (MDFT) and analyzes the main cause of death, as well as the relevant clinical factors associated with survival. Methods: Data of 338 consecutive patients referred to the MDFT center for a new DFU during the 2008–2014 period were analyzed. Follow-up: until death or until 30 April 2020, for up to 12.2 years. Results: Clinical characteristics: median age was 71 years, 92.9% had type 2 diabetes, and about 50% had micro-macrovascular complications. Ulcer characteristics: Wagner grade 1–2 (82.3%), ischemic (49.2%), and infected ulcers (56.2%). During follow-up, 201 patients died (59.5%), 110 (54.7%) due to cardiovascular disease. Kaplan—Meier curves estimated a reduction in survival of 60% with a 95% confidence interval (95% CI), (54.7–65.3) at 5 years. Cox regression analysis adjusted to a multivariate model showed the following associations with mortality, with hazard ratios (HRs) (95% CI): age, 1.07 (1.05–1.08); HbA1c value < 7% (53 mmol/mol), 1.43 (1.02–2.0); active smoking, 1.59 (1.02–2.47); ischemic heart or cerebrovascular disease, 1.55 (1.15–2.11); chronic kidney disease, 1.86 (1.37–2.53); and ulcer severity (SINBAD system) 1.12 (1.02–1.26). Conclusion: Patients with a history of DFU have high mortality. Two less known predictors of mortality were identified: HbA1c value < 7% (53 mmol/mol) and ulcer severity.

Knowledge, attitude, and practice regarding diabetic foot care among Saudi and non-Saudi diabetic patients in Alkharj

“…The risk of developing diabetic foot ulcers is high among DM patients, with the potential of leading to infection, gangrene, amputation, and ultimately death due to sepsis and multiorgan failure syndrome. [ 12 13 ] Therefore, a proactive approach is required to prevent the development of diabetic foot ulcers by appropriate education of patients and clinicians. This study shows that our diabetic patients have good knowledge as well as attitude regarding their diabetic foot care; however, they are lagging behind the diabetic foot care practices, as reflected by the mean score of knowledge, attitude, practice of 8.576 out of 12 (71.6%), 4 out of 5 (80%), and 13 out of 26 (50%), respectively.…”

Global mortality of diabetic foot ulcer: A systematic review and meta‐analysis of observational studies

“…40 Thirteen studies assessed the impact of cardiovascular disease history on mortality. 8,9,[15][16][17][18]21,24,27,32,33,36,40 The pooled HR was 1.449 (95% CI 1.276-1.645, P < .001, I 2 = 74.9%) (Figure 5D). In sensitivity analysis, the pooled HR was stable after omitting any one of the included studies (Figure S11).…”

“…15,26,31 Nine studies reported the effect of gender on mortality. 16,18,21,23,26,30,37,40,44 The study by Iacopi et al 44 was a secondary analysis of the same population in the study performed by Piaggesi et al 38 The pooled HR showed that there was no difference in mortality between the two genders (HR 1.124, 95% CI 0.832-1.519, P = .447) (Figure S5). There was significant heterogeneity (I 2 = 81%).…”

Effect of Hydrogel Use on Healing Diabetic Foot Ulcers: Systematic Review

“…The prevalence of diabetic foot ulcers (DFU) varies from about 1% in Europe, and more than 11% in reports from several African countries [4]. Patients with DFU in Indonesia are 15%, with an amputation rate of 30%, a mortality rate of 32%, and diabetic ulcers are the most common cause of hospitalization by 80% [5].…”