Are current wound classifications valid for predicting prognosis in people treated for limb‐threatening diabetic foot ulcers?

Abstract

This study aims to investigate whether the current wound classifications were valid for the treatment prognosis of subjects treated for limb‐threatening diabetic foot ulcers (LTDFU). A total of 1548 patients with LTDFU and infection were studied, with wounds recorded using the Wagner, Texas, PEDIS and WIfI classifications while major lower extremity amputations (LEAs) or in‐hospital mortality incidences were defined as poor outcomes. Among them, 153 (9.9%) patients received major LEAs and 38 (2.5%) patients died. After adjustments, the Wagner classification and Texas stage as well as clinical factors such as comorbidity with major adverse cardiac events (MACE), being under dialysis and having serum levels of C‐reactive protein (CRP) and albumin were independent factors for prognosis. For patients without dialysis, Wagner and Texas stage stood out independently for prognosis. For patients on dialysis, only levels of CRP (odds ratio [OR] = 2.2 in Wagner, OR = 2.0 in WIfI, OR = 2.2 in Texas, OR = 2.3 in PEDIS) and albumin (OR = 0.4 in four classifications) were valid predictors. The Wagner system and Texas stage were valid for predicting prognosis in treatment for LTDFUs, suggesting a role of vascular perfusion. MACE history, levels of CRP and albumin level should assist in prediction; more significantly, only levels of CRP and albumin appeared valid for those subjects undergoing dialysis.

Evaluation of the healing potential of short-term ozone therapy for the treatment of diabetic foot ulcers

“…In our study, the ozone therapy group exhibited lower levels of ESR, CRP, and PCT compared to the control group, indicating a potential role of ozone in reducing wound inflammation. These inflammatory markers, ESR, CRP, and PCT, have been previously associated with DFUs prognosis (21)(22)(23), aligning with other reports suggesting that ozone therapy can effectively reduce inflammation in DFUs (15, 24,25).The underlying mechanism for these observations may involve the bactericidal effects of ozone. Ozone has the ability to eliminate bacteria within the wound, consequently reducing damage caused by bacterial colonization to the epithelial cells.…”