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

Abstract

BackgroundDiabetes is a life-long and debilitating disease that is fraught with both acute and chronic complications. Of particular concern to sufferers of the disease is the development of foot problems. These problems range from foot deformities to slowly healing or non-healing ulcers (that may necessitate amputation) and in the worst-case scenario, to death. Identification and prompt treatment of comorbid conditions, such as anemia may improve outcome in patients with diabetic foot ulcers (DFU). We determined the prevalence of anemia in Nigerians with DFU and its impact on disease outcome.MethodsWe prospectively followed 336 patients with diabetes hospitalized for DFU and managed by a multidisciplinary team until discharge or death. Demographic and diabetes-related information and ulcer characteristics were documented. We evaluated each patient for neuropathy, vasculopathy and medical co-morbidities. Relevant laboratory and imaging studies were performed. 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.ResultsAnemia was detected in 180(53.6%) subjects with 88(48.9%) of them requiring blood transfusion. Significant demographic and clinical determinants of anemia were ulcer duration more than one month prior to hospitalization (p<0.009), PAD (p<0.001) and presence of gangrene (p<0.001). The comorbid conditions that were significantly associated with anemia included proteinuria (p<0.003), osteomyelitis (p<0.006), moderate (p<0.002) as well as severe (p<0.001) vascular stenosis, history of stroke (p<0.014) and renal impairment (p<0.002). Anemia was significantly associated with poor wound healing (p<0.009), amputation (p<0.036) and risk of death (p<0.034).ConclusionWe detected anemia in more than half of our cohort with DFU. We found significant association between anemia and poor wound healing, amputation and mortality among our studied subjects. Future studies should explore whether prompt correction of anemia in subjects hospitalized for DFU would improve outcome.

Clinical profiles of diabetic foot ulcer patients undergoing major limb amputation at a tertiary care center in North-eastern Tanzania

“…Diabetics have a twofold chance of developing anaemia [ 20 – 23 ]. In anemic diabetic foot ulcers patients a poor prognosis of the ulcer healing is evident [ 21 ]. Costa et al had a similar finding where 89.6% of patients who underwent major limb amputation were anaemic, and anaemia was a significant risk factor for major limb amputation [ 20 , 24 ].…”

“…Costa et al had a similar finding where 89.6% of patients who underwent major limb amputation were anaemic, and anaemia was a significant risk factor for major limb amputation [ 20 , 24 ]. There is more evidence for a strong association between anaemia and amputation [ 21 ]. In diabetic patients with peripheral arterial disease, anaemia further exaggerates the effects of tissue hypoperfusion due to poor oxygen delivery to peripheral tissues and thrombus formation [ 21 ].…”

“…There is more evidence for a strong association between anaemia and amputation [ 21 ]. In diabetic patients with peripheral arterial disease, anaemia further exaggerates the effects of tissue hypoperfusion due to poor oxygen delivery to peripheral tissues and thrombus formation [ 21 ].…”

“…The World Health Organization cut off point for diagnosis of anaemia is a hemoglobin level of 12.0 g/dl for females and 13.0 g/dl for males [19,20]. Diabetics have a twofold chance of developing anaemia [20][21][22][23]. In anemic diabetic foot ulcers patients a poor prognosis of the ulcer healing is evident [21].…”

Antimicrobial and Wound Healing Properties of FeO Fabricated Chitosan/PVA Nanocomposite Sponge

“…Concurrently, iron overload (hemochromatosis), and chronic venous disease (CVD) causes severe complication through specific organ damage in liver, heart, kidney, leg veins, and skin [ 5 ]. Diabetes, anemia, and iron deficiency are intently correlated with diabetic wound healing [ 6 , 7 , 8 ]. Diabetic wound healing is a detrimental impediment in the management of wound healing because of the pathogenic macro and microvascular complications [ 9 , 10 ].…”