Validation of the Ischaemia Severity Scale (ISS) Based on Non-Invasive Vascular Assessments (SEWSS) for Predicting Outcomes of Diabetic Foot Attack

Abstract

Assessment of ischaemia severity includes a variety of measures, such as pedal pulse palpation, the ankle/brachial index (ABI), and the toe/brachial index (TBI), but there is a lack of consensus regarding which ischaemia scale is the most effective for determining outcome prognosis. The purpose of this study is to validate the application of the ischaemia severity scale (ISS) in the effective prediction of wound healing, amputations, and mortality for diabetic foot wounds (DFW). This prospective study included 235 consecutive patients graded according to the Saint Elian Wound Score System (SEWSS). The ISS is part of this system, with patients being scored as non-ischaemic (0) or having mild (1), moderate (2), or severe (3) ischaemia. Age, diabetes duration in years, and ulcer size were found to be associated with a longer mean ischaemia of increasing severity. A trend of reduction in the pulse palpation rates (70.4%, 50%, 8.5% to 0%; p < 0.01), ABI (1.1 ± 0.1, 0.86 ± 0.3, 0.68 ± 0.2, 0.47 ± 0.2, p < 0.01), TBI average values (0.90 ± 0.35, 0.62 ± 0.52, 0.50 ± 0.33, 0.10 ± 0.42, p < 0.01), wound healing success (88.7%, 57.7%, 40.7%, 12.9%; p < 0.01), and delay in weeks (Kaplan–Meier: log-rank 44.2, p < 0.01) was observed with increasing values of the ISS (0, 1, 2, and 3). The odds ratio for adverse outcomes increased for each additional level of ischaemia severity. Thus, we demonstrate that the ISS is useful in effectively predicting adverse outcomes for DFW.

Glycemic Control and Peripheral Arterial Disease in Diabetic Foot Patients

“…In our study, an association was found between age and the probability of having PAD, which is consistent with studies conducted by Kuo-Chin et al [21] (OR 1.04, 95%CI: 1.00-1.07, p<0.05), and that of Zhang et al [22] (OR 1.56, 95%CI: 1.21-1.89, p=0.006) that show that age is an independent risk factor for PAD, as well as that carried out by Martínez-De Jesús et al [13] where age was associated with a higher average ischemia (p<0.01).…”

“…This process can lead to reduced perfusion to the lower extremities, and its prevalence in certain studies has been reported to range between 58% and 84% [20]. However, it's important to note that despite our findings, further diagnostic tests like the toe-brachial index or plethysmography are necessary to determine the presence of PAD conclusively [13,20].…”

“…The dependent variable was peripheral arterial disease (PAD) evaluated using the Ankle Brachial Index (ABI) his assessment adhered to the non-invasive vascular evaluation criteria set by the International Diabetes Federation's Clinical Practice Recommendations of 2017 [10,11]. An ABI value of < 0.9 indicated the presence of PAD [12,13].…”

“…The study was conducted in two stages in the HNGAI DF Outpatient Clinic settings for 24 months with a frequency of 5 times per week from June 17 th , 2015 to July 20 th 2017. In the first stage, each intervention included the obtaining of the written informed consent and completing the clinical history, within which palpation of foot pulses and ABI were considered, using the Ischemia Severity Scale (ISS) [13]. Based on these data, the value of the last HbA1C measurement was subsequently identified among the measurements made in the clinical history.…”

Evaluating Classification Systems of Diabetic Foot Ulcer Severity: A 12-Year Retrospective Study on Factors Impacting Survival

“…The result of this scoring system is the sum of all criteria met by ulceration, ranging from six to thirty points. The severity of the ulceration is established by the obtained value, a distinct prognosis being proposed for each of the three degrees: I-mild, probable successful cure; II-moderate, with a partial threat to the foot, where the prognosis depends on the "state-of-the-art" therapies used and the patient's biological response; and III-severe and life-threatening, where the prognosis does not depend on "state-of-the-art" therapies as a result of the patient's poor biological response [22]; d. The SINBAD Classification System and Score is an acronym that comes from six elements graded according to their severity: ulcer Site, Ischemia, Neuropathy, Bacterial infection, Area, and Depth [23]. The total score ranges between 0 and 6, which is divided into three categories related to the risk of lower limb amputation: low grade, 0-2; moderate grade, 3-4; and high grade, 5-6 [24,25]; e. The Society for Vascular Surgery Lower Extremity Threatened Limb Classification System (WIfI) is a grading system that evaluates the severity of a wound (ranging from 0 for no ulcer to 3 for an extensive, deep ulcer or gangrene involving the forefoot and/or midfoot), ischemia (ranging from 0 to 3, evaluated through the ankle-brachial index, ankle systolic pressure, or transcutaneous oximetry), and foot infection (from absent to severe: limb-and/or life-threatening) [26].…”