The major predictors of amputation and length of stay in diabetic patients with acute foot ulceration

Tabur, Suzan; Eren, Mehmet Ali; Çelik, Yakup; Dağ, Ömer; Sabuncu, Tevfik; Sayıner, Zeynel Abidin; Savaş, Esen

doi:10.1007/s00508-014-0630-5

Cited by 51 publications

(50 citation statements)

References 57 publications

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“…Eleven studies 14,[16][17][18][19][20][21][22][23]28,29 with 43 566 patients included in the meta-analysis compared HbA1c level differences between the 2 groups. The HbA1c level (%) ranged from 8.3 to 12.5 in the group with LEA, and from 7.4 to 11.3 in the group without LEA.…”

Section: Meta-analysis For Hba1c Difference Between Groups With and Wmentioning

confidence: 99%

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HbA1c and Lower Extremity Amputation Risk in Patients With Diabetes

Zhou

Liu

Chen

et al. 2015

The International Journal of Lower Extremity Wounds

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In this meta-analysis, we aimed to assess glycosylated hemoglobin (HbA1c) level and lower extremity amputation (LEA) risk in patients with diabetes. Systematic computerized searches of the PubMed and Web of Knowledge were performed. We compared HbA1c level between groups with LEA and without LEA by meta-analysis; we also examined the dose-response relationship between HbA1c level and LEA risk. Sixteen studies were included in the meta-analysis. Eleven studies with 43,566 patients compared HbA1c between groups with and without LEA. The mean HbA1c (%) ranged from 8.3 to 12.5 in the group with LEA and from 7.4 to 11.3 in the group without LEA. The pooled weighted mean difference was 1.110 (95% confidence interval = 0.510-1.709; Z = 3.63, P = .008). The funnel plot was symmetrical, and Begg's test (z = 0.00, P = 1.000) and Egger's test (t = -0.02, P = .984) suggested no significant publication bias. Six studies with 109,933 patients included in the dose-response meta-analysis. The LEA incidence ranged from 0.3% to 14.6% between different HbA1c levels. Dose-response meta-analysis showed statistically significant association between HbA1c and LEA risk (χ(2) = 65.51, P = .000). In linear model, the odds ratio for LEA incidence was 1.229 (95% confidence interval = 1.169-1.292) for every 1% HbA1c increase. In the spline model, the odds ratio of LEA risk increased with HbA1c levels, especially when HbA1c ranged from 5% to 9%. Our meta-analysis indicates that high level of HbA1c is an important risk factor for LEA in patients with diabetes. This evidence supports the strategy for lowering glucose levels to reduce amputation in patients with diabetes.

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Section: Meta-analysis For Hba1c Difference Between Groups With and Wmentioning

confidence: 99%

“…Six studies 15,20,24-27 (10 cohorts) with 109 933 patients included in the dose-response meta-analysis for HbA1c and LEA risk [10][11][12][13][14][15][18][19]. The LEA incidence ranged from 0.3% to 14.6% between different HbA1c levels.…”

Section: Dose-response Meta-analysis For Hba1c Level and Lea Riskmentioning

confidence: 99%

HbA1c and Lower Extremity Amputation Risk in Patients With Diabetes

Zhou

Liu

Chen

et al. 2015

The International Journal of Lower Extremity Wounds

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“…These lesions can become chronic and can lead to an amputation because of the delayed healing suffered by diabetic patients. The factors associated with a diabetic foot ulcer depend on its etiology, such as neuropathy, ischemia, and infection [8–10]. Patients with neuropathy and insufficient peripheral artery flow have a greater risk of developing ulcers than those that only have peripheral diseases [6,7].…”

Section: Introductionmentioning

confidence: 99%

Clinical and surgical characteristics of infected diabetic foot ulcers in a tertiary hospital of Mexico

Cervantes-García

Salazar-Schettino

2017

Diabetic Foot & Ankle

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Background: The objective of this study was to determine the clinical and surgical characteristics of diabetic foot ulcers in a tertiary level hospital in Mexico. Methods: We performed a longitudinal, descriptive study from July, 2012 to August, 2015 on a sample composed of 100 patients with type 2 diabetes mellitus and infected diabetic foot ulcers. We analyzed socio-demographic variables, comorbidities, characteristics of ulcers, and the applied treatment. Results: We found that the most affected areas were the forefoot (48%) and the plantar region (55%) of the foot. Also, most of the patients arrived with advanced stages of diabetic foot ulcers, since 93% of the lesions were of grades III–V according to the Wagner classification. Moreover, lesions usually present with advanced states of infection, since 60% of the lesions were of grades 3–4 in the PEDIS scale. In addition, the great majority of the patients are prone to complications because we found that 43% of the patients suffered from hypertension, 47% of the patients had chronic kidney disease, and 45% reported smoking. In fact, 45% of the patients eventually suffered an amputation. We also found that the situation is more difficult because the great majority of the patients (96%) have a low level of education and very low income and they do not have any health insurance. Nevertheless, we also found that an efficient treatment can help in avoiding amputations, since 53% of grade IV and 25% of grade V lesions according to the Wagner system did not suffer an amputation. Conclusions: Therefore, an effective antibiotic treatment and an education of the patient on the adequate care of their lesions are essential in increasing the welfare of patients, especially when they have a low level of education.

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“…A DFU characteristic feature is an acute-phase reaction prolongation [5]. Acute-phase reactants C-reactive protein (CRP), white blood cell (WBC), neutrophil count, and platelet are commonly used as a predictor of amputation in the patients with DFU but have only modest accuracy in reflecting DFU disease severity [6, 7]. …”

Section: Introductionmentioning

confidence: 99%

Fibrinogen: A Marker in Predicting Diabetic Foot Ulcer Severity

Guan

Lin

et al. 2016

Journal of Diabetes Research

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Aims. To examine whether fibrinogen levels are a valuable biomarker for assessing disease severity and monitoring disease progression in patients with diabetic foot ulcer (DFU). Methods. A retrospective study was designed to examine the utility of fibrinogen in estimating disease severity in patients with DFU admitted to our hospital between January 2015 and January 2016. In total, 152 patients with DFU were enrolled in the study group, and 52 age and gender matched people with diabetes but no DFU were included as the control group. DFU severity was assessed using Wagner criteria. Results. Patients with DFU were divided into 2 subgroups based on the Wagner criteria. Mean fibrinogen values were significantly higher in patients with DFU grade ≧ 3 compared to those with DFU grades 1-2 (5.23 ± 1.37 g/L versus 3.61 ± 1.04 g/L). Using ROC statistic, a cut-off value of 5.13 g/L indicated the possible amputation with a sensitivity of 81.8% and a specificity of 78.9% (positive predictive value [PPV] 78.6%, negative predictive value [89.0%]). Fibrinogen values were found to be correlated with CRP levels, neutrophil, and WBC count. Conclusions. Fibrinogen levels might be a valuable tool for assessing the disease severity and monitoring the disease progression in patients with DFU.

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The major predictors of amputation and length of stay in diabetic patients with acute foot ulceration

Abstract: Baseline levels of acute-phase reactants, especially CRP, WBC, ESR, and increased Wagner grade, appeared to be helpful in predicting amputation and length of stay in diabetic patients with acute foot ulceration. However, duration of diabetes and glucose control seems to have no effect.

Cited by 51 publications

References 57 publications

HbA1c and Lower Extremity Amputation Risk in Patients With Diabetes

HbA1c and Lower Extremity Amputation Risk in Patients With Diabetes

Clinical and surgical characteristics of infected diabetic foot ulcers in a tertiary hospital of Mexico

Fibrinogen: A Marker in Predicting Diabetic Foot Ulcer Severity

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