Risk Factors for Major Amputation in Diabetic Foot Ulcer Patients

Abstract

Abstarct Background The purpose of our study was to identify the new and the more specific risk factors for major amputation in patients with diabetic foot ulcer (DFU). Methods We used data from the Electronic Medical Record (EMR) database of our hospital from February 2014 to July 2020. Patients with DFU and amputation were included in the study. The logistic regression model was adjusted for demographic characteristics and related comorbidities between major and minor amputation groups. Results Among 3654 patients with DFU, 363 (9.9%) were amputated. Patients with major versus minor amputation, in multivariable logistic regression models, major amputation independent factors included previous amputation history (odds ratio [OR] 2.31 [95% CI 1.17–4.53], p = 0.02), smoking (2.58 [1.31–5.07], p = 0.01), coronary artery disease (CAD) (2.67 [1.35–5.29], p = 0.03), ankle brachial index (ABI) <0.4 (15.77 [7.51–33.13], p < 0.01), Wagner 5 (5.50 [1.89–16.01], p < 0.01), activated partial thromboplastin time (APTT) (1.23 [1.03–1.48], p = 0.01), glycosylated hemoglobin A1c (HbA1c) (1.23 [1.03–1.48], p = 0.03), hemoglobin (Hb) (0.98 [0.96–1.00], p = 0.01), plasma albumin (ALB) (0.88 [0.81–0.95], p < 0.01) and white blood cell (WBC) (1.10 [1.04–1.16], p < 0.01). Conclusion Major amputation was associated with previous amputation history, smoking, CAD, Wagner 5, ABI <0.4, HbA1c, Hb, ALB, WBC, and APTT might be a new independent factor. In view of these factors, early prevention and guidance promptly orientated by multidisciplinary is of great significance to reduce the disability rate and economic burden.

Sonication of Kirschner Wire as a Tool for the Microbiological Diagnosis of Diabetic Foot Infection – Preliminary Results

“…It is possible that non-adherent diabetes mellitus patients avoid an early medical consultation for any cause, including DFI, or do not recognize the solemn threat providing by DFI. A meta-analyses from Shen et al does not find this association, as other studies regarding amputation as an outcome [12][13][14][15].…”

Microbiome Characterization of Infected Diabetic Foot Ulcers in Association With Clinical Outcomes: Traditional Cultures Versus Molecular Sequencing Methods

“…More of these patients had peripheral vascular disease compared to others and their IDFU cultures grew more AMP-C resistant bacteria. PVD was previously associated with the tendency to develop unhealing ulcers in diabetic patients ( Lipsky et al., 2006 ; Lavery et al., 2017 ; Shin et al., 2017 ; Lu et al., 2021 ); however, data regarding the microbiome of ulcers in patients with PVD are lacking. The decreased blood flow characterizing patients with PVD promotes poor wound healing.…”

Foot Osteomyelitis Location and Rates of Primary or Secondary Major Amputations in Patients With Diabetes

“…30 Other patient factors that have been associated with DFO-related major amputation include end-stage renal disease, hypertension, coronary artery disease, PAD, and cerebrovascular disease as well as the duration of diabetes, the occurrence of multiple ulcers, and deep ulcers reaching the bone. 14,16,23,31,33,49,61 Further, pulmonary and bleeding disorders, increased HbA 1c , smoking, elevated inflammatory markers such as C-reactive protein, erythrocyte sedimentation rate, and white blood cells have been described (summarized in Table 7). 2,31,33,34,64 Our data did not identify any additional independent risk factors in addition to the hindfoot location.…”

“…It is a general problem that the diabetic foot population is heterogenous so that generalization of particular findings on the diabetic foot is difficult, and most studies have not had sufficient size to perform multivariate analyses. 31,47,57 Mortality rates of 29.4% to 52% have been reported after transtibial amputations. 13,61 In our study, we noticed a mortality rate of 28.3% after major amputation, which may be related to advanced treatment modalities of patients' comorbidities.…”

“… 14 , 16 , 23 , 31 , 33 , 49 , 61 Further, pulmonary and bleeding disorders, increased HbA 1c , smoking, elevated inflammatory markers such as C-reactive protein, erythrocyte sedimentation rate, and white blood cells have been described (summarized in Table 7 ). 2 , 31 , 33 , 34 , 64 Our data did not identify any additional independent risk factors in addition to the hindfoot location. It is a general problem that the diabetic foot population is heterogenous so that generalization of particular findings on the diabetic foot is difficult, and most studies have not had sufficient size to perform multivariate analyses.…”