Depth and combined infection is important predictor of lower extremity amputations in hospitalized diabetic foot ulcer patients

Abstract

Background/AimsAs the prevalence of diabetes mellitus and its complications increase rapidly, diabetic foot ulcers (DFUs), which are a major diabetic complication, are expected to increase. For prevention and effective treatment, it is important to understand the clinical course of DFUs. The aim of this study was to investigate the natural course and predictors of amputation in patients with DFUs who required hospitalizationMethodsA total of 209 patients with type 2 diabetes, aged 30 to 85 years, who visited emergency department or needed hospitalization due to DFUs were consecutively enrolled from May 2012 to January 2016, by retrospective medical record review. The main outcome was lower extremity amputation (LEA).ResultsAmong 192 patients who completed follow-up, 113 patients (58.9%) required LEAs. Compared to patients without amputation, baseline levels of white blood cell counts and C-reactive protein were higher in patients with amputation. In addition, bone and joint involvement was more frequently observed in patients with amputation. Multivariable regression analysis revealed that combined infection (odds ratio [OR], 11.39; 95% confidence interval [CI], 2.55 to 50.93; p = 0.001) and bone or joint involvement (OR, 3.74; 95% CI, 1.10 to 12.70; p = 0.035) were significantly associated with an increased risk of LEA.ConclusionsThe depth of the wound and combined infection of DFU, rather than the extent of the wound, were significant prognostic factors of LEAs in patients with type 2 diabetes.

<p>Determinants of Diabetic Foot Ulcer Among Adult Patients with Diabetes Attending the Diabetic Clinic in Tikur Anbessa Specialized Hospital, Addis Ababa, Ethiopia: Unmatched Case–Control Study</p>

“…It had been suggested that this condition can be prevented by wearing proper footwear, maintaining hygiene, and performing daily physical examination. 4 But this is inconsistent to the studies conducted in: Saudi Arabia, with a cross-sectional study that states neuropathy was not significantly associated with the development of diabetic foot ulcer, 15 and Arbaminch Hospital, Ethiopia, with a cross-sectional study design which states that neuropathy was not significantly associated with the development of diabetic foot ulcer. 7 The possible reason for this discrepancy could be due to differences in the duration of diabetes mellitus that the patient has had.…”

“…These were significant factors for the development of DFU. [15][16][17] Several studies have attempted to identify risk factors for DFU but did not assess the status of putting moisturizing cream between toes, family support during foot care, and physical activity (exercise) status of the individual as possible risk factors for the development of DFU. [6][7][8][9] Therefore, this study was conducted to determine the effect of these variables on diabetic foot ulcers.…”

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.…”

Karakteristik Diabetic Foot Ulcer (DFU) pada Individu dengan Diabetes Mellitus (DM): Studi Deskripsi – Cross Sectional

“…Terlebih lagi, pada luka yang disebabkan oleh 2 (dua) atau lebih patogen (combined infection) dapat memiliki risiko yang lebih besar. Hal ini sesuai dengan penelitian sebelumnya yang menunjukkan bahwa luka dengan combined infection 11,39 kali lebih berisiko mengalami amputasi (Jeong et al, 2018). Penatalaksanaan infeksi membutuhkan pemilihan infection management yang tepat sesuai dengan hasil pemeriksaan diagnostik dan mikroorganisme, seperti kultur eksudat.…”