Predictive value of the risk factors for amputation of lower extremity in patients with diabetic foot in Al-Karama teaching hospital

Abstract

Background: Diabetic foot disease is a foot that exhibits any pathology that results directly from diabetic mellitus or any long-term chronic complication of diabetes mellitus. The aim of the study was to determine the risk factors and indications for amputations among diabetics.Methods: this clinical prospective study includes 120 diabetic foot patients admitted to AL- Karama teaching hospital from 1st January 2015 to 1st January 2019. All patients assessed for age, gender, duration of diabetes, hyperglycemia at admission and control of diabetes, history of smoking, hypertension, assess dominant foot and examination of diabetic foot lesion and classify it according to Meggit-Wagner grading status, indications for amputation and outcome.Results: The male to female ratio was 2:1. Most frequent age group of patients treated by amputation was between 50-80 years. Among patients treated with amputation (68.33%) of patients had diabetes mellitus for 11-20 years. From patients admitted with diabetic foot (53.33%) were smokers. Regarding hypertension (93.33%) of all patients were hypertensive. It was noted that (65%) of patients lesion occur in dominant foot Regarding Wagner's grading system (36.66%) of patients were grade 4 followed by grade 1 (21.66%). regarding mode of treatment (53.33%) of patients treated by amputation and other treated conservatively. Only 3 patients from 60 died while other discharged well after complete treatment.Conclusions: Increasing in age, long duration of diabetes mellitus, poor control of diabetes, smoking and occurrence of lesion in dominant foot all considered as a significant risk factors for increase liability amputation.

Risk factors that predict major amputations and amputation time intervals for hospitalised diabetic patients with foot complications

“…Previous studies of the potential influences of hypertension, fasting blood glucose level, and HbA1c level on the increased rate of LEAs in DM patients with foot complications showed conflicting results; therefore, further clinical data and evidence are needed. [24][25][26] Hypertension was an insignificant predictor of amputation during our study, which is consistent with the findings of Gürlek et al 27 Some studies indicated that patients with an average HbA1c <7.5% were at higher risk for LEA (approximately 52%) than those with an average HbA1c >7.5%. However, other studies showed that patients with an average HbA1c <7.5% were at lower risk for LEA (approximately 20%) than those with an average HbA1c >7.5%.…”

Comparison of WIFi, University of Texas and Wagner Classification Systems as Major Amputation Predictors for Admitted Diabetic Foot Patients: A Prospective Cohort Study

“…Despite the prevalence, it did not show a significant association with major amputation in their study. The rate was lower in a study by Surriah et al involving 120 diabetic foot patients, hypertension also did not show a significant association with major amputation 28 . In the Thailand Diabetes Registry study the prevalence of hypertension among diabetics was 78.4% but it’s association with major amputation was not determined 29 .…”

Predictive risk factors for lower limb amputations in patients with diabetic foot ulcer in correlation with Wagner’s grading

“…The Wagner, and Texas university classification systems were the most extensively validated classification systems for diabetic foot ulcer outcome prediction It was reported in the study by Sadriwala et al that Wagner grade was strongly associated with amputation as compared to other risk factors on multivariate analysis. [6][7][8][9]29 Ulcers of Wagner grades 4 and 5 denote the presence of local or diffuse gangrene, which are usually due to a combination of ischemia and infection. 27,[30][31][32][33] In our study grade 4 and 5 ulcers were very strongly associated with amputation.…”