Risk Factors Associated with Amputation-Free Survival in Patient with Diabetic Foot Ulcers

Won, Sung Hun; Chung, Chin Youb; Park, Moon Seok; Lee, Taeseung; Sung, Ki Hyuk; Lee, Seung Yeol; Kim, Tae Kyun; Lee, Kyoung Min

doi:10.3349/ymj.2014.55.5.1373

Cited by 53 publications

(48 citation statements)

References 16 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…Several risk factors have been associated with increased risk of amputation in patients with diabetes such as neuropathy, ulcer severity (hazard ratio (HR): 7.99; confidence interval (CI): 3.12 to 20.47), peripheral artery disease (HR: 2.64; CI: 1.52 to 4.59) [ 11 ], infection and diabetes control (measured as Hb1ac%) [ 12 , 13 ]. Also the role of chronicity in DFU is not well explored but might be associated with increased incidence of amputations in diabetic patients and it has been described that ulcer size and depth is a risk factor for amputation [ 12 ].…”

Section: Introductionmentioning

confidence: 99%

Metformin Induces Cell Cycle Arrest, Reduced Proliferation, Wound Healing Impairment In Vivo and Is Associated to Clinical Outcomes in Diabetic Foot Ulcer Patients

et al. 2016

View full text Add to dashboard Cite

BackgroundSeveral epidemiological studies in diabetic patients have demonstrated a protective effect of metformin to the development of several types of cancer. The underlying mechanisms of such phenomenon is related to the effect of metformin on cell proliferation among which, mTOR, AMPK and other targets have been identified. However, little is known about the role that metformin treatment have on other cell types such as keratinocytes and whether exposure to metformin of these cells might have serious repercussions in wound healing delay and in the development of complications in diabetic patients with foot ulcers or in their exacerbation.Material and MethodsHaCaT Cells were exposed to various concentrations of metformin and cell viability was evaluated by a Resazurin assay; Proliferation was also evaluated with a colony formation assay and with CFSE dilution assay by flow cytometry. Cell cycle was also evaluated by flow cytometry by PI staining. An animal model of wound healing was used to evaluate the effect of metformin in wound closure. Also, an analysis of patients receiving metformin treatment was performed to determine the effect of metformin treatment on the outcome and wound area. Statistical analysis was performed on SPSS v. 18 and GraphPad software v.5.ResultsMetformin treatment significantly reduces cell proliferation; colony formation and alterations of the cell cycle are observed also in the metformin treated cells, particularly in the S phase. There is a significant increase in the area of the wound of the metformin treated animals at different time points (P<0.05). There is also a significant increase in the size and wound area of the patients with diabetic foot ulcers at the time of hospitalization. A protective effect of metformin was observed for amputation, probably associated with the anti inflammatory effects reported of metformin.ConclusionsMetformin treatment reduces cell proliferation and reduces wound healing in an animal model and affects clinical outcomes in diabetic foot ulcer patients. Chronic use of this drug should be further investigated to provide evidence of their security in association with DFU.

show abstract

Section: Introductionmentioning

confidence: 99%

Metformin Induces Cell Cycle Arrest, Reduced Proliferation, Wound Healing Impairment In Vivo and Is Associated to Clinical Outcomes in Diabetic Foot Ulcer Patients

et al. 2016

View full text Add to dashboard Cite

show abstract

“…In the stepwise multivariate analysis, dialysis maintained statistical significance (OR = 8·683, P < 0·001). Previous studies have shown that chronic kidney disease (CKD) and current dialysis for end‐stage renal disease (ESRD) were independent risk factors for diabetic foot ulceration and major amputation. Young et al reported that the relative risk of amputation among the diabetic patients was the highest among those who started dialysis.…”

Section: Discussionmentioning

confidence: 99%

“…On the contrary, Winkley et al showed that a lower HbA1c level was associated with higher mortality. Won et al showed that patients with a mean HbA1c level below 7·5% had a 52% higher risk of amputation compared with patients with a mean HbA1c level above 7·5%. In our study, HbA1c was not found to be a predictive factor.…”

Section: Discussionmentioning

confidence: 99%

Risk factors for major amputation in hospitalised diabetic foot patients

Namgoong

Jung

Han

et al. 2015

International Wound Journal

View full text Add to dashboard Cite

Diabetic foot ulcers are the main cause of non-traumatic lower extremity amputation. The objective of this study was to evaluate the risk factors for major amputation in diabetic foot patients. Eight hundred and sixty diabetic patients were admitted to the diabetic wound centre of the Korea University Guro Hospital for foot ulcers between January 2010 and December 2013. Among them, 837 patients were successfully monitored until complete healing. Ulcers in 809 patients (96⋅7%) healed without major amputation and those in 28 patients (3⋅3%) healed with major amputation. Data of 88 potential risk factors including demographics, ulcer condition, vascularity, bioburden, neurology and serology were collected from patients in the two groups and compared. Among the 88 potential risk factors, statistically significant differences between the two groups were observed in 26 risk factors. In the univariate analysis, which was carried out for these 26 risk factors, statistically significant differences were observed in 22 risk factors. In a stepwise multiple logistic analysis, six of the 22 risk factors remained statistically significant. Multivariate-adjusted odds ratios were 11⋅673 for ulcers penetrating into the bone, 8⋅683 for dialysis, 6⋅740 for gastrointestinal (GI) disorders, 6⋅158 for hind foot ulcers, 0⋅641 for haemoglobin levels and 1⋅007 for fasting blood sugar levels. The risk factors for major amputation in diabetic foot patients were bony invasions, dialysis, GI disorders, hind foot locations, low levels of haemoglobin and elevated fasting blood sugar levels.

show abstract

“…It is estimated that approximately 15–25% of diabetic patients develop diabetic foot ulcers during the course of the disease. People with diabetes can progress into chronic ulcers often leading to amputation if not treated promptly [ 4 – 6 ]. Age, male gender, and long duration of diabetes are the other factors associated with amputation [ 4 , 7 ].…”

Section: Introductionmentioning

confidence: 99%

Isolation and Antibiotic Susceptibility of the Microorganisms Isolated from Diabetic Foot Infections in Nemazee Hospital, Southern Iran

Anvarinejad

Pouladfar

Japoni

et al. 2015

Journal of Pathogens

View full text Add to dashboard Cite

Background. Diabetic foot infections (DFIs) are a major public health issue and identification of the microorganisms causing such polymicrobial infections is useful to find out appropriate antibiotic therapy. Meanwhile, many reports have shown antibiotic resistance rising dramatically. In the present study, we sought to determine the prevalence of microorganisms detected on culture in complicated DFIs in hospitalized patients and their antibiotic sensitivity profiles. Methods. A cross-sectional study was conducted for a period of 24 months from 2012 to 2014 in Nemazee Hospital, Shiraz, Iran. The demographic and clinical features of the patients were obtained. Antimicrobial susceptibility testing to different agents was carried out using the disc diffusion method. Results. During this period, 122 aerobic microorganisms were isolated from DFIs. Among Gram-positive and Gram-negative bacteria, Staphylococcus spp. and E. coli were the most frequent organisms isolated, respectively. Of the isolates, 91% were multidrug while 78% of S. aureus isolates were methicillin resistant. 53% of Gram-negative bacteria were positive for extended-spectrum β-lactamase. Conclusion. Given the involvement of different microorganisms and emergence of multidrug resistant strains, clinicians are advised to consider culture before initiation of empirical therapy.

show abstract

Risk Factors Associated with Amputation-Free Survival in Patient with Diabetic Foot Ulcers

Cited by 53 publications

References 16 publications

Metformin Induces Cell Cycle Arrest, Reduced Proliferation, Wound Healing Impairment In Vivo and Is Associated to Clinical Outcomes in Diabetic Foot Ulcer Patients

Metformin Induces Cell Cycle Arrest, Reduced Proliferation, Wound Healing Impairment In Vivo and Is Associated to Clinical Outcomes in Diabetic Foot Ulcer Patients

Risk factors for major amputation in hospitalised diabetic foot patients

Isolation and Antibiotic Susceptibility of the Microorganisms Isolated from Diabetic Foot Infections in Nemazee Hospital, Southern Iran

Contact Info

Product

Resources

About