All-Cause Mortality After Diabetes-Related Amputation in Barbados

Abstract

OBJECTIVE -To determine the mortality rate after diabetes-related lower-extremity amputation (LEA) in an African-descent Caribbean population.RESEARCH DESIGN AND METHODS -We conducted a prospective case-control study. We recruited case subjects (with diabetes and LEA) and age-matched control subjects (with diabetes and no LEA) between 1999 and 2001. We followed these groups for 5 years to assess mortality risk and causes.RESULTS -There were 205 amputations (123 minor and 82 major). The 1-year and 5-year survival rates were 69 and 44% among case subjects and 97 and 82% among control subjects (case-control difference, P Ͻ 0.001). The mortality rates (per 1,000 person-years) were 273.9 (95% CI 207.1-362.3) after a major amputation, 113.4 (85.2-150.9) after a minor amputation, and 36.4 (25.6 -51.8) among control subjects. Sepsis and cardiac disease were the most common causes of death.CONCLUSIONS -These mortality rates are the highest reported worldwide. Interventions to limit sepsis and complications from cardiac disease offer a huge potential for improving post-LEA survival in this vulnerable group.

Diabetic Foot Disease in People with Advanced Nephropathy and Those on Renal Dialysis

“…There is some circumstantial evidence to support this assertion; in a case-control study to determine mortality rates after diabetes-related amputation in African-Caribbean blacks, Hambleton et al [62] found that the high mortality rates were due to sepsis (49% of cases) followed by cardiac disease (45%). Although this study was not performed primarily on dialysis subjects, it nevertheless highlighted the fact that vulnerability to sepsis augments mortality rates.…”

Gender Differences in Diabetes-related Lower Extremity Amputations

“…Epidemiologic studies indicate the increased risk of atherosclerotic complications among patients with diabetes is particularly pronounced in women [30], and cardiac disease, including congestive heart failure, is one of the most common causes of inpatient mortality associated with diabetes-related LEAs [17,23]. One study of diabetesrelated LEAs among Native Americans reported interactions between gender and cardiovascular disease mortality, suggesting a higher LEA-associated cardiovascular disease mortality risk among women with LEAs [31].…”

Бактеріальний “Пейзаж” Гнійного Осередку Та Принципи Антибактеріальної Терапії У Хворих Із Синдромом Діабетичної Стопи

“…Досить часто до флори гнійних вогнищ приєднуються госпітальні штами, серед яких стафі-локок та синьогнійна паличка є домінуючими куль-турами. Характерною рисою внутрішньо-лікарня-них мікроорганізмів є їх висока вірулентність і стій-кість до антибактеріальних препаратів, у зв'язку з З ДОСВІДУ РОБОТИ чим запальні процеси, викликані цими мікробами, характеризуються тяжким перебігом і не завжди сприятливим прогнозом [1,2,8,10].…”