Clinical characteristics and risk factors of lower extremity amputation in the diabetic inpatients with foot ulcers

Abstract

ObjectivesTo analyze clinical characteristics of the diabetic inpatients with foot ulcers and explore the risk factors of lower extremity amputation (LEA) in West China Hospital of Sichuan University.MethodsA retrospective analysis was performed based on the clinical data of the patients with diabetic foot ulcer (DFU) hospitalized in West China Hospital of Sichuan University from January 1, 2012 to December 31, 2020. The DFU patients were divided into three groups: non-amputation, minor amputation, and major amputation groups. The ordinal logistic regression analysis was used to identify the risk factors for LEA.Results992 diabetic patients (622 males and 370 females) with DFU were hospitalized in the Diabetic Foot Care Center of Sichuan University. Among them, 72 (7.3%) (55 minor amputations and 17 major amputations) cases experienced amputation, and 21(2.1%) refused amputation. Excluding the patients who refused amputation, the mean age and duration of diabetes of and HbA1c the 971 patients with DFU, were 65.1 ± 12.3 years old, 11.1 ± 7.6 years, and 8.6 ± 2.3% respectively. The patients in the major amputation group were older and had longer course of diabetes for a longer period of time than those in the non-amputation and minor amputation groups. Compared with the non-amputation patients (55.1%), more patients with amputation (minor amputation (63.5%) and major amputation (88.2%)) suffered from peripheral arterial disease (P=0.019). The amputated patients had statistically lower hemoglobin, serum albumin and ankle brachial index (ABI), but higher white blood cell, platelet counts, fibrinogen and C-reactive protein levels. The patients with amputation had a higher incidence of osteomyelitis (P = 0.006), foot gangrene (P < 0.001), and a history of prior amputations (P < 0.001) than those without amputation. Furthermore, a history of prior amputation (odds ratio 10.194; 95% CI, 2.646-39.279; P=0.001), foot gangrene (odds ratio 6.466; 95% CI, 1.576-26.539; P=0.010) and ABI (odds ratio 0.791; 95% CI, 0.639-0.980; P = 0.032) were significantly associated with LEAs.ConclusionsThe DFU inpatients with amputation were older with long duration of diabetes, poorly glycemic control, malnutrition, PAD, severe foot ulcers with infection. A history of prior amputation, foot gangrene and a low ABI level were the independent predictors of LEA. Multidisciplinary intervention for DFU is essential to avoid amputation of the diabetic patients with foot ulcer.

Neutrophil Extracellular Traps (NETs) Are Associated with Type 2 Diabetes and Diabetic Foot Ulcer Related Amputation: A Prospective Cohort Study

“…In our study population, rural residents and less than high school-educated individuals compose 74% and 82% of all patients with DFU, respectively, and our amputation rate was 26%. This rate is much higher than in the economically developed area of the country of 7.3%, as reported by Gong et al[ 32 ].…”

“…The findings of the current study indicate that previous DFU surgery is also a risk factor for amputation (95% CI 1.735—7.039, P < 0.001). It is generally accepted and proved that patients who have experienced debridement or amputations for DFU are more likely to need additional amputations in the future [ 32 ]. An earlier amputation indicates that the patient has already gone through serious diabetic foot condition-related consequences.…”

Renal function as risk factor for diabetic foot ulcers: A meta‐analysis

“…Following an assessment of 414 pertinent examinations, 16 tests released between 2004 and 2023 were included in the meta-analysis since they matched the criteria for inclusion. [10][11][12][13][14][15][16][17][18][19][20][21][22][23][24][25] Table 2 summarises the findings of these investigations. 808 914 people with DM were in the used studies' starting point; 5805 of them were DFUs, and 803 109 were non-DFUs.…”

“…16 inspections from 2004 to 2023 were enrolled for the present meta-analysis, comprising 808 914 individuals with DM at the studies' starting point; 5805 of them were DFUs, and 803 109 were non-DFUs. [10][11][12][13][14][15][16][17][18][19][20][21][22][23][24][25] DFU had significantly higher chronic renal failure, higher serum Creatinine, and a low estimated glomerular filtration rate compared to non-DFU in persons with DM. Yet, attention should be paid to its values since some comparisons had a low number of selected examinations, for example, estimated glomerular filtration rate.…”

Identification of potential immunologic resilience in the healing process of diabetic foot ulcers

“…Diabetic foot ulcers (DFUs) are a severe complication of diabetes, affecting millions of diabetic patients worldwide. 1 DFU typically presents as ulcers, infections or destruction of foot tissue, and due to neuropathy and microvascular changes, it is the leading cause of non‐traumatic lower limb amputations. 2 It is estimated that in 2008, the lifetime risk of a patient with diabetes developing a foot ulcer was 25%.…”