Analysis of risk factors for amputation in patients with diabetic foot ulcers: a cohort study from a tertiary center

Abstract

Objective: This study aimed to analyze risk factors for amputation (overall, minor and major) in patients with diabetic foot ulcers (DFUs). Methods: 407 patients with DFUs (286 male, 121 female; mean age = 60, age range = 32-92) who were managed in a tertiary care centre from 2009 to 2019 were retrospectively identified and included in the study. DFUs were categorized based on the Meggit-Wagner, PEDIS, S(AD)SAD, and University of Texas (UT) classification systems. To identify amputation risk-related factors, results of patients with DFUs who underwent amputations (minor or major) were compared to those who received other adjunctive treatments using Chi-Square, one-way analysis of variance (ANOVA) and Spearman correlation analysis. Results: The mean C-reactive protein (CRP) and White Blood Cell (WBC) values were significantly higher in patients with major or minor amputation than in those without amputation. The mean Neutrophil (PNL), Platelets (PLT), wound width, creatinine and sedimentation (ESR) values were significantly higher in patients with major amputation compared to other groups of patients. Elevated levels of High-density lipoprotein (HDL), Hemoglobin (HGB) and albumin were determined to be protective factors against the risk of amputation. Spearman correlation analysis revealed a positive-sided, strong-levelled, significant relation between Wagner grades and amputation status of patients. Conclusion: This study has identified specific factors for major and minor amputation risk of patients with DFUs. Especially infection markers such as CRP, WBC, ESR and PNL were higher in the amputation group. Most importantly, Meggit Wagner, one of the four different classification systems used in the DFUs, was determined to be highly associated with patients’ amputation risk. Level of Evidence: Level IV, Prognostic Study

Efficacy of telemedicine applications in patients with diabetic foot ulcers: A focus on mortality and major amputation rates

“…14 Demirkol et al reported higher white blood cell (WBC) and CRP levels in amputation group (major and minor) and higher ESR, elevated creatinine level and increased wound width in major amputation group compared with the limb salvage group. 15 The studied variables as the cause of ulcers were similar in both groups, which aligns with established information.…”

“…Nather et al reported that history of stroke, age above 60, nephropathy, peripheral vascular disease, above‐the‐threshold HbA1c levels, ankle‐brachial index below 0.8 as significant predictors for major limb amputation 14 . Demirkol et al reported higher white blood cell (WBC) and CRP levels in amputation group (major and minor) and higher ESR, elevated creatinine level and increased wound width in major amputation group compared with the limb salvage group 15 . The studied variables as the cause of ulcers were similar in both groups, which aligns with established information.…”

Effect of diabetic foot ulcers and other risk factors on the prevalence of lower extremity amputation: A meta‐analysis

“…A total of 32 publications from a total of 3245 connected investigations that were examined that met the inclusion criteria and were published between 1998 and 2023 were chosen and included in the study 10‐41 . The results of these researches are presented in Table 2.…”

“…In studies that were considered for the meta‐analysis, 9934 subjects were in the chosen studies' starting point, and 2906 of them were with LEA 10‐41 . Male gender, smoking, previous foot ulcer, osteomyelitis, gangrene, hypertension, and WBCC were significantly shown to be an RF in LEA in subjects with DFUs.…”

Risk factor analysis for diabetic foot ulcer‐related amputation including Controlling Nutritional Status score and neutrophil‐to‐lymphocyte ratio

“…Wagner grading was used to assess ulcer depth, osteomyelitis and necrosis/gangrene on a scale ranging from 0 to 5. Almost all DFU‐related amputation risk studies have highlighted the reliability of the Wagner classification in predicting amputation 16,17 . Because of the ulcer severity that increases with the Wagner classification grade, more extensive wounds often require amputation.…”