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

Abstract

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 > 1 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.

Breakdown of Diabetic Foot Ulcer Care during the First Year of the Pandemic in Poland: A Retrospective National Cohort Study

“…As a consequence of the breakdown, Poland recorded a dramatic increase in the percentage of deaths among hospitalized patients related to DFU. The relatively low percentage of in-hospital mortality in comparison with Nigeria (21.4%) in the pre-pandemic period might be connected with the better organization of DFU care [ 56 ]. There is no other data which compares in-hospital mortality related to DFU during the pandemic with the pre-pandemic period.…”

Major limb amputation and mortality in patients with neuro‐ischaemic lower extremity wounds managed in a tertiary hospital: Focus on the differences among patients with diabetes, peripheral arterial disease and both

“…In terms of co-morbidities, the presence of cardiovascular disease and ESRF being the risk factors of major limb amputation and mortality in NIU patients is in line with existing evidence. [34][35][36][37][38][39] Moreover, cardiovascular disease is more prevalent in NIU patients with PAD as both share similar atherosclerosis risk factor profiles 14 ; even after adjustment for known atherosclerosis-related risk factors, patients with PAD were still prospectively associated with higher risk of all-cause mortality compared with those having wounds without ischaemic component. 14,16,[40][41][42] Also, patients with ESRF tend to have more extensive arterial calcifications, impaired microcirculatory perfusion and higher likelihood of drug-resistant wound infection.…”

Knowledge, Attitudes, and Practices Associated With Diabetic Foot Prevention Among Rural Adults With Diabetes in North China

“…Diabetic foot is one of the most difficult complications to treat among all the complications of diabetes ( 5 ). Diabetic foot ulcers (DFU) are associated with high morbidity and mortality globally ( 6 ). A diabetic limb is amputated every 20 s according to estimates ( 7 ).…”