Effect of limb preservation status and body mass index on the survival of patients with limb-threatening diabetic foot ulcers

Lin, Cheng-Wei; Hsu, Brend Ray‐Sea; Tsai, Jir-Shiong; Yang, Hui-Mei; Lin, Jr-Rung; Huang, Chung-Huei; Hung, Shih-Yuan; Huang, Yu‐Yao

doi:10.1016/j.jdiacomp.2016.09.011

Cited by 28 publications

(19 citation statements)

References 43 publications

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“…To date, no study has investigated the influence of the ABI on survival rate in diabetic amputees. However, ABI value has been reported to be an independent risk factor for survival in patients with diabetes and foot ulcers regardless of the LEA status [ 8 , 9 ]. The ABI has also been reported to be a predictor of MACEs because PAD is thought to be a manifestation of systemic atherosclerosis rather than only localized disease [ 26 , 27 ].…”

Section: Discussionmentioning

confidence: 99%

Survival and associated risk factors in patients with diabetes and amputations caused by infectious foot gangrene

Huang

Lin

Yang

et al. 2018

Journal of Foot and Ankle Research

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BackgroundInfectious gangrene of the foot is a serious complication of diabetes that usually leads to a certain level of lower-extremity amputation (LEA). Nevertheless, the long-term survival and factors associated with mortality in such patients have yet to be elucidated.MethodsA total of 157 patients with type 2 diabetes who received treatment for infectious foot gangrene at a major diabetic foot center in Taiwan from 2002 to 2009 were enrolled, of whom 90 had major LEAs (above the ankle) and 67 had minor LEAs (below the ankle). Clinical data during treatment were used for the analysis of survival and LEA, and survival was tracked after treatment until December 2012.ResultsOf the 157 patients, 109 died, with a median survival time of 3.12 years and 5-year survival rate of 40%. Age [hazard ratio 1.04 (95% confidence interval 1.01–1.06)], and major LEA [1.80 (1.05–3.09)] were independent factors associated with mortality. Patients with minor LEAs had a better median survival than those with major LEAs (5.5 and 1.9 years, respectively, P < 0.01). An abnormal ankle-brachial index was an independent risk factor [odds ratio 3.12 (95% CI 1.18–8.24)] for a poor outcome (major LEA) after adjusting for age, smoking status, hypertension, major adverse cardiac events, and renal function.ConclusionsEfforts to limit amputations below the ankle resulted in better survival of patients with infectious foot gangrene. An abnormal ankle-brachial index may guide physicians to make appropriate decisions with regards to the amputation level.

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Section: Discussionmentioning

confidence: 99%

Survival and associated risk factors in patients with diabetes and amputations caused by infectious foot gangrene

Huang

Lin

Yang

et al. 2018

Journal of Foot and Ankle Research

Self Cite

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“…The association of obesity and reduced risk of all- cause mortality is in line with the findings of other researchers and could be related to the reported better wound healing among obese subjects [ 32 ]. Another explanation of this reduced risk among obese individuals could be explained on the basis of obesity paradox, where obese diabetic patients had reduced mortality risk [ 33 ] based on several hypotheses including: better mobilization of progenitor cells, decreased thromboxane production or increased production of soluble tumor necrosis factor receptor which may contribute to survival from cardiovascular disease [ 34 ].…”

Section: Discussionmentioning

confidence: 99%

All-cause mortality among diabetic foot patients and related risk factors in Saudi Arabia

et al. 2017

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BackgroundAlthough Diabetes mellitus is a major public health problem in the Middle East and North Africa (MENA) region with high rates of diabetic foot complications, there are only limited data concerning mortality among such a high risk group. Therefore, the main aim of the current study was to assess all-cause mortality and its related predictors among diabetic patients with and without diabetic foot complications.MethodsUsing data from the Saudi National Diabetes Registry (SNDR), a total of 840 patients with type 1 or type 2 diabetes aged ≥25 years with current or past history of diabetic foot ulcer (DFU) or diabetes related lower extremity amputation (LEA) were recruited in 2007 from active patients’ files and followed up to 2013. These patients were compared with an equal number of age and gender matched diabetic patients without foot complication recruited at the same period. All patients were subjected to living status verification at 31st December 2013.ResultsThe all-cause mortality rate among patients with DFU was 42.54 per 1000 person-years and among LEA patients was 86.80 per 1000 person-years among LEA patients for a total of 2280 and 1129 person-years of follow up respectively. The standardized mortality ratio (SMR) (95% CI) was 4.39 (3.55–5.23) and 7.21 (5.70–8.72) for cases with foot ulcer and LEA respectively. The percentage of deceased patients increased by almost twofold (18.5%) among patients with diabetic foot ulcer and more than threefold (32.2%) among patients with LEA compared with patients without diabetic foot complications (10.7%). The worst survival was among patients with LEA at 0.679 and the presence of diabetic nephropathy was the only significant independent risk factor for all-cause mortality among patients with diabetic foot complications. On the other hand, obese patients have demonstrated significantly reduced all-cause mortality rate.ConclusionsDiabetic patients with diabetic foot complications have an excess mortality rate when compared with diabetic counterparts without foot complications and the general population. Early interventions to prevent foot ulceration and consequent LEA as well as all the measurements for reducing the prevalence of microvascular and macrovascular complications should be considered.

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“…Diabetic foot, especially those with infection, is a type of consumptive disease. Patients with a higher BMI may have a better nutritional status and, hence, more strength to cope with a severe illness [41]. The apparent protective effect of a higher BMI on the foot ulcer risk may be an instance of 'the obesity paradox', a phenomenon of better health outcomes associated with an elevated body weight [42].…”

Section: Plos Onementioning

confidence: 99%

Risk factors for lower extremity amputation in patients with diabetic foot ulcers: A meta-analysis

2020

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Effect of limb preservation status and body mass index on the survival of patients with limb-threatening diabetic foot ulcers

Abstract: For the patients treated for DFUs, major - but not minor - LEA was associated with poor survival compared with the limb-preserved group. The MST had positive correlation with BMI levels for patients with limb-preserved and minor LEA, but not for those with major LEA.

Cited by 28 publications

References 43 publications

Survival and associated risk factors in patients with diabetes and amputations caused by infectious foot gangrene

Survival and associated risk factors in patients with diabetes and amputations caused by infectious foot gangrene

All-cause mortality among diabetic foot patients and related risk factors in Saudi Arabia

Risk factors for lower extremity amputation in patients with diabetic foot ulcers: A meta-analysis

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