Prevalence and Correlates of Lower-Extremity Amputation in Patients With Diabetic Foot Ulcer in Jeddah, Saudi Arabia

Abstract

This cross-sectional study investigated the prevalence and correlates of lower-extremity amputation (LEA) in a Saudi population with diabetic foot ulcer. The study population consisted of 91 participants, with a median age of 55.0 years. Biomarkers were measured following standard protocols. Local symptoms of foot ulcer, including peripheral neuropathy (PN), peripheral artery disease (PAD), and foot infection were diagnosed by standard objective diagnostic tools or diagnosed clinically by a specialized surgeon. The severity of foot ulcer was classified according to the Wagner wound classification system. The prevalence of LEA was 29.7% in this population. The odds ratio for LEA comparing extreme tertiles was 2.42 (95% confidence interval [CI] = 0.70-8.45; P for trend = .03) for ulcer size and 0.22 (95% CI = 0.06-0.87; P for trend = .03) for high-density lipoprotein cholesterol. C-reactive protein and homocysteine levels were each positively associated with odds of LEA, but the associations became nonsignificant in multivariable models. Participants with foot infection showed a significantly higher adjusted prevalence of LEA (40.7%, 95% CI = 27.1%-54.3%) compared with those without foot infections (19.3%, 95% CI = 6.0%-32.4%, P = .03). Participants with Wagner grade ≥3 presented a significantly higher prevalence (40.5%, 95% CI = 27.8%-53.2%) than those with Wagner grade of 1 or 2 (16.4%, 95% CI = 2.4%-30.5%, P = .02). Participants with PN and PAD showed nonsignificantly higher prevalence of LEA. We found a relatively high prevalence of LEA as well as several clinical markers and local symptoms associated with LEA in this Saudi population with diabetic foot ulcer.

Risk factors of amputation in diabetic foot infections

“…When these significant predictive factors were analyzed in a multivariate analysis, only Wagner grading system was shown to be strongly associated with amputation (Table 4). [6][7][8][9] This is likely because most of the patients in this study presented to the department of surgery when infection or ischaemic change had already occurred, and so the overall amputation rate was relatively high. Also the percentage of distal amputation was higher as compared to below knee amputation (40%), which could be due to decreased perfusion distally, thus leading to delay in wound healing, and also increased occurrence of osteomyelitis of phalanges.…”

Green synthesis of silver nanoparticles by Nigella sativa extract alleviates diabetic neuropathy through anti-inflammatory and antioxidant effects

“…In KSA, a diagnosis was carried on out on 552 patients with diabetes mellitus where they were found to have diabetic neuropathy ( Wang et al, 2016 ). In a study carried out in KSA, of 91 patients with foot ulcer, the incidences of lower extremity amputation were 29.7 percent, and there was a rise of amputation risk in patients with peripheral arterial disease and diabetic neuropathy, especially those patients with a more advanced infection and ulceration stage ( Ahmed et al, 2015 ).…”

Effects of the Low-Level Laser Therapy (LLLT) in the process of healing diabetic foot ulcers

“…On the basis of the parameter that 50% of the non traumatic amputations in lower limbs happen in diabetic people the number of amputation cases attributed to the Diabetes Mellitus was estimated 10,11 . One of the patients in the control group evolved to a transfemoral amputation, according to the Fontaine classification.…”