Three Years Survival and Factor Predicting Amputation or Mortality in Patients with High Risk for Diabetic Foot Ulcer in Fatmawati General Hospital, Jakarta

Abstract

Background: Diabetic foot is one of major complication in diabetes patients with unfavorable outcome. Survival study in outpatients is limited and factors related are inconsistent. Survival and its modifiable risk factors should be identified early since the foot at risk status to reduce amputation/mortality in type 2 diabetes mellitus (T2DM). Objective: The aims of this study were to investigate survival probability for amputation or mortality, compare different ulcer risk classification, and figure out the relation of status of ulcer risk, age, gender, diabetes duration, body mass index, fasting plasma glucose, HbA1C, and LDL with amputation or mortality. Methods: This is a retrospective cohort study of 487 T2DM subjects who visited internal medicine outpatient clinic in Fatmawati General Hospital since January-December 2016. Status of ulcer risk and risk factors were extracted from medical record and lower-extremity amputation or mortality was observed in 3 years from baseline. Result: Three years overall survival is 85.7% (SE 0.17). Patients with high risk for foot ulcer have survival probability of 80.2% (SE 0.027), which is lower compared to non-high risk for foot ulcer with survival probability of 91.8% (SE 0.019). Patients with high risk for foot ulcer (aHR 2.386 [95% CI 1.356-4.20]; P = .003), aged ≥60 years old (aHR 2.051 [95% CI 1.173-3.585]; P = .012), and HbA1C ≥7% (aHR 2.022 [95% CI 1.067-3.830]; P = .031) were independently associated with amputation or mortality. Conclusion: T2DM patients with high risk for foot ulcer have lower survival probability and higher risk for amputation or mortality in 3 years compared to patients with non-high risk for foot ulcer. Status of ulcer risk, age ≥60 years, and HbA1C ≥7% were associated with amputation or mortality in 3 years observation.

Multicomponent prediction of 2‐year mortality and amputation in patients with diabetic foot using a random survival forest model: Uric acid, alanine transaminase, urine protein and platelet as important predictors

“…Most previous studies concentrated on the prognosis prediction of patients with DFU 5,10,11,20–22 . Few studies predicted adverse outcomes in DF patients 6 .…”

“…First, many were cross‐sectional studies, which provide no perspective with regard to the progression of the disease 10,11 . Second, multiple variables have not always been used in prediction models for patients with DF or diabetic foot ulcer (DFU) 5,6,10,11 . For example, in one longitudinal cohort study, 69 variables in five domains were initially included, but only three were included in the final model 6 .…”

“…The International Working Group on Diabetic Foot (IWGDF) also classified patients with DFU according to variables in multiple dimensions, including patient‐related factors, limb‐related factors and ulcer‐related factors 12 . Mortality and amputation in patients with DF or DFU are also associated with multiple aetiological factors, which have been classified in various ways in previous studies 5,6,10,11 . Moreover, in addition to logistic and Cox models, machine learning algorithms have been used for the early diagnosis of disease and the differention of disease subtypes, 6,11,13–16 and may represent superior methods of linking multiple risk factors and outcomes.…”

“…4 DF commonly leads to hospitalisation and is associated with adverse outcomes such as mortality and amputation. [5][6][7][8][9][10] Thus, it is necessary to identify patients who are at risk of mortality and amputation and implement early preventive and therapeutic measures for inpatients with DF. Previous studies of the mortality and amputation of patients with DF have had a number of limitations.…”

Nomogram Prediction for the Risk of Diabetic Foot in Patients With Type 2 Diabetes Mellitus

“…Most of the current research on the relevant risk factors of diabetic foot has focused on intervening in the progression of diabetic foot to prevent severe ulcers and amputations (21)(22)(23)(24). Although these studies are important, we believe that how to prevent diabetic patients from developing diabetic foot is more important and critical.…”