Predictors of major lower limb amputation in type 2 diabetic patients referred for hospital care with diabetic foot syndrome

Abstract

PurposeThis study was conducted to determine the risk factors of major lower extremity amputations in type 2 diabetic patients referred for hospital care with diabetic foot syndrome.Patients and methodsThis retrospective study involved 225 type 2 diabetic patients referred for management of diabetic foot syndrome at King Abdullah University Hospital in the period between January 2014 and December 2015. A structured customized diabetic foot data collection form with diabetic foot characteristics chart was used for documentation of relevant information, which checks for age, sex, body mass index, smoking, duration of diabetes, diabetic control therapy, associated hypertension, cardiac diseases, stroke, chronic renal impairment, renal replacement therapy (hem-dialysis), and history of diabetes-related complication in both feet prior to the study period. The predictors for major lower limb amputations were compared between groups using chi-square test, and binary logistic regression was used to determine the factors associated with major amputation.ResultsTwenty-seven limbs underwent major amputations with an overall rate of major amputation of 11.6%. The following predictors were found to be associated with the higher incidence of major lower limb amputations: duration of diabetes ≥15 years, HbA1c ≥8%, patients on insulin, with hypertension, cardiac diseases, chronic renal impairment, stroke, having gangrene, higher number of components, higher Wagner classification, and ischemia. However, the rate did not differ significantly between men and women.ConclusionPresentation with gangrenous tissue and poor glycemic control are the important risks and significant predictive factors for type 2 diabetes-related major lower limb amputations.

Major lower limb amputations in Far North Queensland

“…Interestingly, all dialysis‐dependent patients undergoing lower limb amputation also had concurrent diabetes . Multiple studies have concluded that patients requiring dialysis are at higher risk than the general population for MLLA, and this study confirms that in our cohort . It has also been suggested that there is a correlation between the severity of chronic kidney disease and amputation, which may be independent of clinically apparently peripheral artery disease …”

“…27 Multiple studies have concluded that patients requiring dialysis are at higher risk than the general population for MLLA, and this study confirms that in our cohort. [33][34][35] It has also been suggested that there is a correlation between the severity of chronic kidney disease and amputation, which may be independent of clinically apparently peripheral artery disease. 35 The rates of BKA in this study as a proportion of total MLLAs (62.7%) was comparable to other Australian cohorts, with Lim et al 15 reporting 58.6% and a study looking at 5 years' worth of data from all Australian states reporting 57.3%.…”

Factors associated with lower‐extremity amputation in patients with diabetic foot ulcers in a Chinese tertiary care hospital

“…According to Pemayun et al, significant risk factors of LEA in their study included hypertension status (OR 2.85, 95% CI: 1.23‐6.60), presence of PAD (OR 6.80, 95% CI: 2.67‐17.32), presence of foot necrosis or gangrene (OR 25.88, 95% CI: 6.97‐96.13), FPG ≥ 126 mg/dL (OR 9.43, 95% CI: 1.13‐78.78), HbA1c ≥8% (OR 9.54, 95% CI: 2.03‐44.89), and triglycerides ≥150 mg/dL (OR 4.16, 95% CI: 1.75‐9.86); thus, good control of blood glucose and lipid levels and management of comorbidities such as PAD and hypertension are considered important factors in reducing amputation risk. According to a recent retrospective study by Shatnawi et al, higher HbA1c was also significantly associated with increased risk of major amputation (OR 4.0; 95% CI: 1.3‐12.4) in multivariate analysis, and diabetes duration longer than 15 years (OR 6.0), renal dysfunction (OR 3.5), and gangrene (OR 4.2) were also closely associated with increased risk of major amputation. A meta‐analysis by Zhou et al showed a statistically significant association between HbA1c and LEA risk (χ (2) = 65.51, P < .001), and the OR for LEA incidence was 1.229 (95% CI: 1.169‐1.292) for every 1% HbA1c increase in linear model; moreover, for HbA1c between 5% and 9%, the OR of LEA risk increased with HbA1c levels in the spline model.…”

“…Khalfallah et al reported that age was the only independent predictor for major lower‐extremity amputation (LEA) in DFU patients with a threshold age value of no less than 65 years in their study . In another study by Shatnawi et al, the presence of gangrenous tissues and uncontrolled blood glucose levels were significant predictive factors for type 2 diabetes‐related major LEA . The risk factors for LEA associated with diabetic foot diseases are extensive, including microvascular diseases, PAD, infections, long diabetes duration, poor glycaemic control, old age, and cardiovascular comorbidities .…”

Can supernatant from immortalized adipose tissue MSC replace cell therapy? An in vitro study in chronic wounds model

“…Chronic wound patients have a reduced ability to undergo normal tissue repair and are more susceptible to ulcers, resulting in patient trauma, and often the need for limb amputation [1,2]. At present, chronic wounds impact four million Europeans per year, and at least 1% of people living in high economy countries will experience a complex wound in their lifetime [3,4].…”