Predictors of Lower-Extremity Amputation in Patients With an Infected Diabetic Foot Ulcer

Abstract

OBJECTIVEInfection commonly complicates diabetic foot ulcers and is associated with a poor outcome. In a cohort of individuals with an infected diabetic foot ulcer, we aimed to determine independent predictors of lower-extremity amputation and the predictive value for amputation of the International Working Group on the Diabetic Foot (IWGDF) classification system and to develop a risk score for predicting amputation. RESEARCH DESIGN AND METHODSWe prospectively studied 575 patients with an infected diabetic foot ulcer presenting to 1 of 14 diabetic foot clinics in 10 European countries. RESULTSAmong these patients, 159 (28%) underwent an amputation. Independent risk factors for amputation were as follows: periwound edema, foul smell, (non)purulent exudate, deep ulcer, positive probe-to-bone test, pretibial edema, fever, and elevated C-reactive protein. Increasing IWGDF severity of infection also independently predicted amputation. We developed a risk score for any amputation and for amputations excluding the lesser toes (including the variables sex, pain on palpation, periwound edema, ulcer size, ulcer depth, and peripheral arterial disease) that predicted amputation better than the IWGDF system (area under the ROC curves 0.80, 0.78, and 0.67, respectively). CONCLUSIONSFor individuals with an infected diabetic foot ulcer, we identified independent predictors of amputation, validated the prognostic value of the IWGDF classification system, and developed a new risk score for amputation that can be readily used in daily clinical practice. Our risk score may have better prognostic accuracy than the IWGDF system, the only currently available system, but our findings need to be validated in other cohorts.Infection is a frequent complication of diabetic foot ulcers, with up to 58% of ulcers being infected at initial presentation at a diabetic foot clinic, increasing to 82% in patients hospitalized for a diabetic foot ulcer (1). These diabetic foot infections (DFIs) are associated with poor clinical outcomes for the patient and high costs for both the patient and the health care system (2). Patients with a DFI have a 50-fold increased risk of hospitalization and 150-fold increased risk of lowerextremity amputation compared with patients with diabetes and no foot infection (3). Among patients with a DFI, ;5% will undergo a major amputation and 20-30% a

Análise dos fatores de risco relacionados às amputações maiores e menores de membros inferiores em hospital terciário

“…23 In diabetics, local infections, with plantar ulcers, edema, and hyperemia, are known high-risk factors for amputations. 8,24 However, the present study observed that only sepsis was related to major amputations, irrespective of the presence of local infection. In these cases, the importance of taking a treatment decision immediately to prevent progression to septic shock and death cannot be overstated.…”

Preventing and treating foot complications associated with diabetes mellitus

“…20 In a multi centre study from Europe, infection was confirmed to be a major contri buting factor to lower extremity amputation in patients with diabetes mellitus; markers of severity of infection, such as periwound oedema, foul smell and raised Cprotein levels, were all found to independently predict amputation. 21 In a study from Iran of patients with diabetes mellitus who presented with foot infections, 45% of participants required local or major amputation. 22 Amputations also frequently result from diabetic foot problems in Asia, and several of the Caribbean islands have some of the highest amputation rates in the world.…”

Asociação entre internação hospitalar por diabetes mellitus e amputação de pé diabético

“…Con base en los hallados, los investigadores desarrollaron nuevos puntajes que no son contemplados por el sistema de clasificación por el IWGDF que pueden ser fácilmente empleados en la práctica clínica (13) .…”