Risk factors for primary major amputation in diabetic patients

Santos, Vanessa Prado dos; Silveira, Denise Rabelo da; Caffaro, Roberto Augusto

doi:10.1590/s1516-31802006000200004

Cited by 72 publications

(78 citation statements)

References 29 publications

(47 reference statements)

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“…A notable amount of literature exists on risk factors for amputation among patients with diabetes. A number of risk factors have been reported, including age (31,32), gender (33,34), ischemic heart disease (31), hypertension (31), peripheral artery disease (35), nephropathy (36), duration of diabetes (37) and hemoglobin A1C (38,39). However, there are inconsistencies among studies regarding smoking as a risk factor for diabetic foot amputation.…”

Section: Discussionmentioning

confidence: 99%

Smoking increases the risk of diabetic foot amputation: A meta-analysis

et al. 2017

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Abstract. Accumulating evidence suggests that smoking is associated with diabetic foot amputation. However, the currently available results are inconsistent and controversial. Therefore, the present study performed a meta-analysis to systematically review the association between smoking and diabetic foot amputation and to investigate the risk factors of diabetic foot amputation. Public databases, including PubMed and Embase, were searched prior to 29th February 2016. The heterogeneity was assessed using the Cochran's Q statistic and the I 2 statistic, and odds ratio (OR) and 95% confidence interval (CI) were calculated and pooled appropriately. Sensitivity analysis was performed to evaluate the stability of the results. In addition, Egger's test was applied to assess any potential publication bias. Based on the research, a total of eight studies, including five cohort studies and three case control studies were included. The data indicated that smoking significantly increased the risk of diabetic foot amputation (OR=1.65; 95% CI, 1.09-2.50; P<0.0001) compared with non-smoking. Sensitivity analysis demonstrated that the pooled analysis did not vary substantially following the exclusion of any one study. Additionally, there was no evidence of publication bias (Egger's test, t=0.1378; P=0.8958). Furthermore, no significant difference was observed between the minor and major amputation groups in patients who smoked (OR=0.79; 95% CI, 0.24-2.58). The results of the present meta-analysis suggested that smoking is a notable risk factor for diabetic foot amputation. Smoking cessation appears to reduce the risk of diabetic foot amputation.

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Section: Discussionmentioning

confidence: 99%

Smoking increases the risk of diabetic foot amputation: A meta-analysis

et al. 2017

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“…Tavares e colaboradores (2009) (2006), obteve-se média de idade de 60,2±12,4 anos para 99 pacientes portadores de pé diabético; desses, 51 pacientes (51,5%) sofreram amputação maior (SANTOS et al, 2006). Em nossa amostra, a idade média de pacientes com amputação maior observada foi maior (64,4 ± 11,6).…”

Section: Discussionunclassified

Fatores De Risco Para Amputação Maior Em Pacientes Portadores De Pé Diabético

et al. 2017

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RESUMOO pé diabético está entre as complicações crônicas do Diabetes mellitus, estando relacionado com altas taxas de amputação de membros inferiores. Dentre as especialidades médicas, uma das que mais destacam-se no estudo dessa enfermidade encontra-se a cirurgia vascular. Sabendo disso, a Universidade Estadual de Ponta Grossa conta com um projeto de extensão denominado "Acompanhamento dos pacientes do ambulatório de angiologia e cirurgia vascular", que visa diversas atividades acadêmicas e sociais. Inúmeras linhas de pesquisa são provenientes deste projeto extensionista, sendo uma dessas pesquisas totalmente voltada para o pé diabético. A confecção deste artigo foi feita exclusivamente com dados obtidos do projeto de extensão, cujo objetivo é identificar fatores de risco para amputação maior não traumática em pacientes portadores de pé diabético. Trata-se de um estudo de coorte, entre 2012 e 2015, estando incluídos 43 pacientes internados por pé diabético. A primeira coleta de dados foi realizada através de um exame clínico, incluindo dados sociodemográfios. A segunda coleta, para registrar o desfecho (amputação maior), foi realizada via telefone. Os fatores de risco avaliados foram diversos, entre os quais estão amputação menor prévia, arteriopatia e hipertensão arterial sistêmica. Não foi encontrado valor estatisticamente significativo para os fatores de risco avaliados. Concluiu-se que os fatores de risco estudados não apresentaram associação com o desfecho amputação maior.Palavras-chave: pé diabético; amputação; fatores de risco.

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“…The prevalence of peripheral vascular disease is about 10% in diabetics and 2.6% in non-diabetics; peripheral vascular disease was associated with an approximately two-fold increased risk of foot infection in a multivariate model. 5,6 Arterial insufficiency will result in prolonged healing, indicating an elevated risk of amputation. 2 The studies have shown that amputation rate can be reduced more than 50% by early diagnosis of peripheral vascular disease and vascular intervention.…”

Section: Discussionmentioning

confidence: 99%

“…The risk factors for major amputation were neuropathy, peripheral arterial disease, infection, history of prior foot ulcer or amputation, structural foot deformity, trauma, charcot foot, poor glycemic control, older age, male sex, ascending lymphangitis, calcaneal lesions, Wagner grade 5 lesions, duration of diabetes and Gram-positive microorganisms in cultures. 2,6 Although early diagnosis and control of risk factors are essential to prevent complications, the poor outcomes of the diabetic foot infections cannot be easily predicted. Therefore, we conducted a retrospective study to determine the value of patient characteristics, laboratory parameters and imaging procedures in the assessment of the severity and prognosis of diabetic foot infections.…”

mentioning

confidence: 99%

Diabetic Foot Infections and the Role of Doppler USG in Prognosis

Tunçcan¹,

Dizbay²,

Hızel³

et al. 2012

Turkiye Klinikleri J Med Sci

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A AB BS ST TR RA AC CT T O Ob bj je ec ct ti iv ve e: : To determine the value of patient characteristics, laboratory parameters, and imaging procedures in the assessment of the severity and prognosis of diabetic foot infections (DFIs). M Ma at te er ri ia al l a an nd d M Me et th ho od ds s: : Demographic and clinical characteristics of 71 patients with DFI were evaluated retrospectively. Patient characteristics and clinical data including diabetes status and wound related information, laboratory and radiologic findings, and outcomes were recorded. R Re es su ul lt ts s: : In patients between 35 and 60 years old, the frequency of recurrent diabetic foot infections were four and half-times higher than in those over 60 years (OR 4.55, 95% CI 1.50-13.83, p= 0.007). The white blood cell count was significantly higher in severe infections (p<0.05). Gram negative microorganisms were predominantly isolated from the wound cultures of patients aged between 35 and 65 years (p= 0.04). Pathological findings in Doppler Ultrasonography (dUSG) was correlated with smoking (p= 0.004). There was no significant association between the severity of the wound and pathological findings in dUSG. However, presence of a pathological finding in dUSG was correlated with amputation (p=0.001). Moreover, the probability of poor outcome was four-fold higher in patients with a pathology in dUSG in the logistic regression analysis (OR 4.32, 95% CI, 1.24-14.97, p= 0.025). C Co on nc cl lu us si io on n: : In the management of empirical therapy, gram negative microorganisms should be considered, especially in patients of 35-65 years of age. Pathological findings in dUSG were found to be related to poor outcome such as amputation. Therefore, all patients with diabetic foot should be screened with dUSG to identify those at risk for amputation.K Ke ey y W Wo or rd ds s: : Diabetic foot; risk factors; prognosis; ultrasonography, doppler Ö ÖZ ZE ET T A Am ma aç ç: : Bu çalışmada, diyabetik ayak enfeksiyonlarında klinik, laboratuvar ve radyolojik bulguların enfeksiyon şiddetine ve prognozuna etkisi değerlendirilmiştir. G Ge er re eç ç v ve e Y Yö ön nt te em ml le er r: : Diyabetik ayak enfeksiyonu olan 71 hasta retrospektif olarak incelenmiştir. Hastaların özellikleri, diyabet ve diyabetik ayak yarası ile ilgili bilgileri, laboratuvar ve radyolojik bulguları ve prognozları değerlendirilmiştir. B Bu ul lg gu ul la ar r: : Hastalarda tekrarlayan lezyon gelişme sıklığının, 35-60 yaş arası hasta grubunda, >60 yaş hasta grubuna göre yaklaşık 4.5 kat fazla olduğu saptanmıştır [Odds Oranı (OO) 4.55, %95 GA 1,50-13,83, p= 0,007]. Şiddetli enfeksiyon ile lökositoz arasında anlamlı bir ilişki saptanmıştır (p< 0,05). Yaşları 35-65 arasında olan hastaların yara yeri kültürlerinde gram negatif mikroorganizlar daha sık izole edilmiştir (p=0,04). Sigara kullanma ile Doppler ultrasonografi (USG) incelemesinde patoloji olması arasında anlamlı bir ilişki bulunmuştur (p= 0,004). Doppler USG'de patoloji ile yaranın ciddiyeti arasında herhangi bir ilişki gözlenmemiştir. ...

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Risk factors for primary major amputation in diabetic patients

Cited by 72 publications

References 29 publications

Smoking increases the risk of diabetic foot amputation: A meta-analysis

Smoking increases the risk of diabetic foot amputation: A meta-analysis

Fatores De Risco Para Amputação Maior Em Pacientes Portadores De Pé Diabético

Diabetic Foot Infections and the Role of Doppler USG in Prognosis

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