Anemia in Patients With Diabetic Foot Ulcer

Abstract

The aim of this study was to describe the characteristics of diabetic foot ulcer (DFU) patients with anemia and assess the relationship between anemia and DFU outcome. A retrospective cohort study was conducted on patients with DFU who attended our hospital from May 2007 to September 2014. All of the variables in the DFU patients with and without anemia were compared. In this study, 353 subjects were included, anemia was present in 236 patients (66.9%). These patients were significantly male, more likely to be a smoker, had a lower level of serum albumin and worse kidney function, more likely to use at least 2 types of antibiotics and had a worse perfusion of the lower limb, a larger and deeper ulcer and a more severe infection. A multivariate analysis showed that male sex, lower serum albumin, and worse kidney function were independent predictors of anemia in DFU patients. Additionally, in multivariate models, anemia was one of the variables that was most significantly associated with adverse outcomes and with similar findings for secondary outcomes. Receiver operating characteristic analysis determined a hemoglobin cutoff of 12.3 g/dL (females) and 12.1 g/dL (males) to identify a high-risk population of DFU patients who would have adverse outcomes. So anemia is common in patients with DFU. Although typically mild or moderate, anemia has been associated with substantial morbidity and mortality in patients with DFU.

Anemia in patients with diabetic foot ulcer and its impact on disease outcome among Nigerians: Results from the MEDFUN study

“…We concluded therefore, that diabetic nephropathy (DN) was a significant determinant of anemia in the index study. This concurs with the findings of Chuan et al [12] who also reported a significant association between anemia and DN among their patients with DFU. Reports from previous studies indicate that anemia complicating chronic kidney disease (CKD) due to diabetes, tended to be more severe and occur much earlier than in nondiabetic CKD [22,23].…”

“…This may account for the higher prevalence of anemia reported. Using Receiver Operating Curve (ROC) analysis, an Hb cut-off of 12.3g/dl (female) and 12.1g/dl (male) in one study, was reported to better identify patients with DFU who are at high risk of adverse outcomes [12].…”

“…Anemia was defined as an Hb<12g/dL. Details of the MEDFUN study protocol has been published elsewhere [12]. We present the results of the sub-group analysis of patients with anemia to determine its prevalence and impact on disease outcome in patients with DFU in the MEDFUN study.…”

Association between estimated glomerular filtration rate and outcomes in patients with diabetic foot ulcers: a 3-year follow-up study

“…Meanwhile, chronic kidney disease is commonly complicated with PAD and uremic neuropathy, which harm the process of wound healing (23,24). Hypoalbuminemia, anemia and edema caused by renal failure may also explain the effect of moderately or severely decreased eGFR on poor ulcer healing in DFU (25,26,27).…”

Factors associated with amputation among patients with diabetic foot ulcers in a Saudi population

“…Previous research has shown that the duration of diabetes mellitus [ 10 ], a history of previous amputations or foot ulceration [ 11 ], inadequate glycaemic control [ 12 ], a history of hypertension [ 13 ], hyperlipidaemia [ 13 ], the presence of PAD [ 13 ], a history of peripheral neuropathy [ 14 ], a history of osteomyelitis [ 15 ], and wound severity [ 16 ] are independent risk factors for LEA. Furthermore, old age [ 17 ], a history of smoking [ 18 ], anaemia [ 19 ], an elevated white blood cell count [ 20 ], hypoalbuminemia [ 19 ], and the presence of microvascular [ 15 , 21 ] and macrovascular complications [ 22 , 23 ] are all believed to contribute to these risk factors. Nevertheless, different studies have reported different findings, and the published data identifying such predictors for diabetes-related LEA in Saudi Arabia are scarce.…”