Meta‐analysis of risk factors for amputation in diabetic foot infections

Şen, Pınar; Demırdal, Tuna; Emir, Büşra

doi:10.1002/dmrr.3165

Cited by 132 publications

(103 citation statements)

References 41 publications

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“…Overall, Wagner grades were significantly correlated with the increased risk of amputation . A recent meta‐analysis demonstrated that Wagner Grades 4 (OR 4.3) and 5 (OR 6.4) were identified as predictors of amputation in DFU . It is rational that higher Wagner scores, especially grades 4 and 5, were strongly associated with amputation in the present study (OR 20.947) as Wagner grades 4 and 5 indicate the presence of localised or diffused gangrene because of ischaemia and infection.…”

Section: Discussionsupporting

confidence: 52%

Factors associated with lower‐extremity amputation in patients with diabetic foot ulcers in a Chinese tertiary care hospital

Guo

Yue

Qian

et al. 2019

International Wound Journal

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Providing a better understanding of the risk factors for amputation in this particular region, Hunan province, in China might help patients with diabetic foot ulcers receive timely and appropriate medical care and help prevent amputation. Diabetic foot ulcer patients referred to the Third Xiangya Hospital during the period between December 2014 and September 2018 were enrolled. Participants who underwent amputations and received conservative treatments were compared using univariate and multivariate analyses to identify the independent predictors of amputation. Those who required amputation presented significantly higher levels of white blood cell counts, platelet counts, erythrocyte sedimentation rate, C‐reactive protein, and glycated haemoglobin (HbA1c) levels. However, levels of haemoglobin, postprandial plasma C‐peptide, triglyceride, high‐density lipoprotein cholesterol, albumin, and uric acid were decreased in patients with amputations. Patients with more advanced Wagner grades had much higher rates of amputation. Multivariable‐adjusted odds ratios in stepwise logistic regression model was 1.317 for HbA1c (95% CI: 1.015‐1.709), 0.255 for triglyceride (95% CI: 0.067‐0.975), and 20.947 for Wagner grades (95% CI: 4.216‐104.080). Independent risk factors for amputation in these Chinese diabetic foot ulcer patients included an elevated HbA1c level, lower triglyceride level, and higher Wagner grades.

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Section: Discussionsupporting

confidence: 52%

Factors associated with lower‐extremity amputation in patients with diabetic foot ulcers in a Chinese tertiary care hospital

Guo

Yue

Qian

et al. 2019

International Wound Journal

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“…Diabetic foot ulcers are a costly public health concern, with a large proportion leading to amputation or infection; DFUs are also associated with a reduced quality of life . The lifetime risk of developing a DFU is 15‐25% . However, once ulcerated, DFU recurrence rates are 40% within the first year and up to 65% after 5 years post‐healing .…”

Section: Introductionmentioning

confidence: 99%

The role of foot pressure measurement in the prediction and prevention of diabetic foot ulceration—A comprehensive review

Chatwin

Abbott

Boulton

et al. 2019

Diabetes Metabolism Res

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The predominant risk factor of diabetic foot ulcers (DFU), peripheral neuropathy, results in loss of protective sensation and is associated with abnormally high plantar pressures. DFU prevention strategies strive to reduce these high plantar pressures.Nevertheless, several constraints should be acknowledged regarding the research supporting the link between plantar pressure and DFUs, which may explain the low prediction ability reported in prospective studies. The majority of studies assess vertical, rather than shear, barefoot plantar pressure in laboratory-based environments, rather than during daily activity. Few studies investigated previous DFU location-specific pressure. Previous studies focus predominantly on walking, although studies monitoring activity suggest that more time is spent on other weight-bearing activities, where a lower "peak" plantar pressure might be applied over a longer duration.Although further research is needed, this may indicate that an expression of cumulative pressure applied over time could be a more relevant parameter than peak pressure. Studies indicated that providing pressure feedback might reduce plantar pressures, with an emerging potential use of smart technology, however, further research is required. Further pressure analyses, across all weight-bearing activities, referring to location-specific pressures are required to improve our understanding of pressures resulting in DFUs and improve effectiveness of interventions.

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“…Wound infection is a common and serious problem in patients with diabetes, and is admitted as a risk factor for lower extremity amputations, especially with multidrug-resistant infection (10)(11)(12). On the surface of ulceration, structured community of microbial cells would form a biofilm gradually to advance their own survival.…”

Section: Discussionmentioning

confidence: 99%

A Severe Diabetic Foot Ulcer With Intermediate Cuneiform Displacement and Multidrug-Resistant Pseudomonas aeruginosa Infection: A Rare Case Report

et al. 2020

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Diabetic foot ulcer (DFU) is considered as one of the most serious and prevailing complications of diabetes mellitus, while it is the major cause of amputations in diabetic patients. Herein, we reported an acquired severe traumatic DFU with an intermediate cuneiform hairline fracture and displacement in a 55-year old male (Grade IV of Wagner classification; Grade III of IWGDF classification). The Pseudomonas aeruginosa was identified in pus culture. Data of antibiotic susceptibility testing indicated that the isolates of Pseudomonas aeruginosa were multi-drug resistant. Routine debridement, clearing displaced intermediate cuneiform and drainage were performed to facilitate the outflow of pus and pressure mitigation. Dressing with Prontosan solution and gel was applied to the wound, and meropenem was systemically administrated in addition to effective glycemic control. The DFU has been fully healed after ∼40-day treatment. For this case, clearing the displaced and fractured intermediate cuneiform is essential for the heal of the DFU in addition to the common strategy for DFU treatment, i.e., the combination of debridement, pressure mitigation, wound dressing with Prontosan, antibiotic selection and effective glycemic control. This case report might have value for the treatment of complex DFU with bone fracture and displacement, reducing the risk of amputation.

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Meta‐analysis of risk factors for amputation in diabetic foot infections

Cited by 132 publications

References 41 publications

Factors associated with lower‐extremity amputation in patients with diabetic foot ulcers in a Chinese tertiary care hospital

Factors associated with lower‐extremity amputation in patients with diabetic foot ulcers in a Chinese tertiary care hospital

The role of foot pressure measurement in the prediction and prevention of diabetic foot ulceration—A comprehensive review

A Severe Diabetic Foot Ulcer With Intermediate Cuneiform Displacement and Multidrug-Resistant Pseudomonas aeruginosa Infection: A Rare Case Report

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