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Chen Y, Zhuang J, Yang C. Development of a major amputation prediction model and nomogram in patients with diabetic foot. Postgrad Med J 2024:qgae087. [PMID: 39005047 DOI: 10.1093/postmj/qgae087] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2024] [Revised: 05/06/2024] [Indexed: 07/16/2024]
Abstract
BACKGROUND Diabetes mellitus, as one of the world's fastest-growing diseases, is a chronic metabolic disease that has now become a public health problem worldwide. The purpose of this research was to develop a predictive nomogram model to demonstrate the risk of major amputation in patients with diabetic foot. METHODS A total of 634 Type 2 Diabetes Mellitus (T2DM) patients with diabetic foot ulcer hospitalized at the Air Force Medical Center between January 2018 and December 2023 were included in our retrospective study. There were 468 males (73.82%) and 166 females (26.18%) with an average age of 61.64 ± 11.27 years and average body mass index of 24.45 ± 3.56 kg/m2. The predictive factors were evaluated by single factor logistic regression and multiple logistic regression and the predictive nomogram was established with these features. Receiver operating characteristic (subject working characteristic curve) and their area under the curve, calibration curve, and decision curve analysis of this major amputation nomogram were assessed. Model validation was performed by the internal validation set, and the receiver operating characteristic curve, calibration curve, and decision curve analysis were used to further evaluate the nomogram model performance and clinical usefulness. RESULTS Predictors contained in this predictive model included body mass index, ulcer sites, hemoglobin, neutrophil-to-lymphocyte ratio, blood uric acid (BUA), and ejection fraction. Good discrimination with a C-index of 0.957 (95% CI, 0.931-0.983) in the training group and a C-index of 0.987 (95% CI, 0.969-1.000) in the validation cohort were showed with this predictive model. Good calibration were displayed. The decision curve analysis showed that using the nomogram prediction model in the training cohort and validation cohort would respectively have clinical benefits. CONCLUSION This new nomogram incorporating body mass index, ulcer sites, hemoglobin, neutrophil-to-lymphocyte ratio, BUA, and ejection fraction has good accuracy and good predictive value for predicting the risk of major amputation in patients with diabetic foot.
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Affiliation(s)
- Yi Chen
- Department of Endocrinology, Air Force Medical Center, No. 30 Fucheng Road, Haidian District, Beijing 100142, China
- Graduate School of China Medical University, Shenyang 110000, China
| | - Jun Zhuang
- Department of Ear Reconstruction, Plastic Surgery Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100000, China
| | - Caizhe Yang
- Department of Endocrinology, Air Force Medical Center, No. 30 Fucheng Road, Haidian District, Beijing 100142, China
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Luo Y, Liu C, Li C, Jin M, Pi L, Jin Z. The incidence of lower extremity amputation and its associated risk factors in patients with diabetic foot ulcers: A meta-analysis. Int Wound J 2024; 21:e14931. [PMID: 38972836 PMCID: PMC11227953 DOI: 10.1111/iwj.14931] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2023] [Revised: 05/06/2024] [Accepted: 05/08/2024] [Indexed: 07/09/2024] Open
Abstract
This study analysed the incidence of lower extremity amputation and its associated risk factors in patients with diabetic foot ulcers. This study systematically searched both Chinese and English databases, including CNKI, Wanfang, VIP, PubMed, EMBASE and Web of Science, to identify cohort studies related to lower extremity amputation and associated risk factors in patients with diabetic foot ulcers up to October 2023. The patients were stratified based on whether they underwent lower extremity amputation, and relevant data, including basic information, patient characteristics, complications, comorbidities and pertinent laboratory test data, were extracted from the included studies. The literature quality assessment in this study utilized the Newcastle-Ottawa Scale to screen for high-quality literature, resulting in the inclusion of 16 cohort studies, all of which were of at least moderate quality. Meta-analysis of outcome indicators was conducted using the Stata 14.0 software. The results indicate that the overall amputation rate of lower extremities in patients with diabetic foot ulcers is 31% (0.25, 0.38). Among the 16 variables evaluated, gender (male), smoking history, body mass index (BMI), hypertension, cardiovascular disease, kidney disease, white blood cell count, haemoglobin and albumin levels were found to be correlated with the occurrence of lower extremity amputation in patients with diabetic foot ulcers. However, no significant correlation was observed between age, diabetes type, duration of diabetes, stroke, glycosylated haemoglobin, creatinine and total cholesterol levels and lower extremity amputation in patients with diabetic foot ulcers. This meta-analysis indicates that the overall amputation rate in patients with diabetic foot ulcers is 31%. Factors such as gender (male), smoking history, high BMI, hypertension, cardiovascular disease, kidney disease, white blood cell count, haemoglobin and albumin levels are identified as significant risk factors for lower extremity amputation in diabetic foot ulcer patients. These findings suggest that attention should be focused on these risk factors in patients with diabetic foot ulcers to reduce the risk of lower extremity amputation. Therefore, preventive and intervention measures targeting these risk factors are of significant importance in clinical practice. (Systematic review registration: https://www.crd.york.ac.uk/PROSPERO/, identifier [CRD42024497538]).
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Affiliation(s)
- Yinli Luo
- Department of DermatologyYanbian University HospitalJilinChina
- Department of Medical CosmetologyYanbian University HospitalJilinChina
| | - Chang Liu
- Department of Medical CosmetologyYanbian University HospitalJilinChina
| | - Chuying Li
- Department of Medical CosmetologyYanbian University HospitalJilinChina
| | - Meitong Jin
- Department of DermatologyYanbian University HospitalJilinChina
- Department of Medical CosmetologyYanbian University HospitalJilinChina
| | - Longquan Pi
- Department of Medical CosmetologyYanbian University HospitalJilinChina
| | - Zhehu Jin
- Department of DermatologyYanbian University HospitalJilinChina
- Department of Medical CosmetologyYanbian University HospitalJilinChina
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Li J, Wang H, Yang Y, Wang A, Shi Y, Cui T. Efficacy of the combination of Chinese herbal medicine and negative pressure wound therapy in the treatment of patients with diabetic foot ulcer: A meta-analysis. Int Wound J 2024; 21:e14536. [PMID: 38069543 PMCID: PMC10961048 DOI: 10.1111/iwj.14536] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2023] [Revised: 11/18/2023] [Accepted: 11/19/2023] [Indexed: 03/25/2024] Open
Abstract
This study aimed to systematically evaluate the clinical efficacy of Chinese herbal medicine combined with negative pressure wound therapy (NPWT) in the treatment of diabetic foot ulcers (DFU). Computerised searches of the China National Knowledge Infrastructure, Wanfang, Chinese BioMedical Literature Database, PubMed, Cochrane Library and Embase databases were conducted for randomised controlled trials on the use of Chinese herbal medicines combined with NPWT for the treatment of DFU. The search period ranged from the time of establishment of each database to July 2023. Literature screening and data extraction were performed independently by two investigators, and the quality of the included studies was assessed. The meta-analysis was performed using Review Manager 5.4 software. A total of 25 studies were analysed, including 1777 DFUs, with 890 and 887 patients in the experimental and control groups, respectively. The results showed that the treatment of DFUs with a Chinese herbal medicine in combination with NPWT increased the overall effectiveness (odds ratio [OR] = 4.32, 95% confidence interval [CI]: 2.96-6.30, p < 0.001), wound healing rate (mean difference [MD] = 18.35, 95% CI: 13.07-23.64, p < 0.001) and ankle brachial index (MD = 0.10, 95% CI: 0.06-0.14, p < 0.001); reduced the wound healing time (MD = -11.01, 95% CI: -13.25 to -8.78, p < 0.001) and post-treatment wound area (MD = -1.73, 95% CI: -2.46 to -1.01, p < 0.001); decreased the C-reactive protein level (MD = -3.57, 95% CI: -5.13 to -2.00, p < 0.001); and increased vascular endothelial growth factor level (MD = 19.20, 95% CI: 8.36-30.05, p < 0.001). Thus, Chinese herbal medicines combined with NPWT can effectively promote wound healing, reduce inflammation and shorten the disease course in patients with DFU, while demonstrating precise clinical efficacy.
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Affiliation(s)
- Jin Li
- Department of Development Research CenterLiaoning University of Traditional Chinese MedicineShenyangLiaoningChina
| | - Hong‐Yu Wang
- Department of School of NursingLiaoning University of Traditional Chinese MedicineShenyangLiaoningChina
| | - Yu‐Feng Yang
- Department of School of NursingLiaoning University of Traditional Chinese MedicineShenyangLiaoningChina
| | - An‐Na Wang
- Department of School of NursingLiaoning University of Traditional Chinese MedicineShenyangLiaoningChina
| | - Yan Shi
- Department of School of NursingLiaoning University of Traditional Chinese MedicineShenyangLiaoningChina
| | - Ting‐Bao Cui
- Department of Development Research CenterLiaoning University of Traditional Chinese MedicineShenyangLiaoningChina
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Truong DH, Ngoo AK, Tsai S, Yang AK, Wukich DK, Lavery LA. Success of transmetatarsal amputation for limb salvage in patients with peripheral artery disease. Int Wound J 2024; 21:e14360. [PMID: 37622404 PMCID: PMC10781589 DOI: 10.1111/iwj.14360] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2023] [Accepted: 08/07/2023] [Indexed: 08/26/2023] Open
Abstract
Limb salvage is a difficult path for patients to travel as there is no guarantee of the outcome, often the major factor is perfusion. For patients who underwent transmetatarsal amputation (TMA), success rate is crucial as the next option is most likely a major amputation. We performed a 10 years (2010-2020) retrospective review of patients that underwent a TMA and had an angiogram or computed tomography angiography (CTA) perioperatively at the Dallas VA Medical Center. Failure after TMA was defined as a patient requiring a proximal amputation within 1 year. There were 125 TMAs performed between 2010 and 2020 at the institution. Forty-four (35.2%) patients had an angiogram/CTA peri-operative and met the inclusion criteria. Seventeen subjects (38.6%) had a higher level of amputation. Of the 17 failures, 2 (11.8%) patients had no patent vessel runoff to the foot, 9 (52.9%) had one vessel, 4 (23.5%) had two vessels, and 2 (11.8%) had three vessels runoff. One vessel runoff to the foot yielded a high rate of poor outcomes (56.3%) defined as a higher level of amputation. Two or more vessels runoff to the foot had over 75% success of limb salvage with a TMA.
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Affiliation(s)
- David H. Truong
- Surgical Service, Podiatry SectionVeterans Affairs North Texas Health Care SystemDallasTexasUSA
- Department of Orthopaedic SurgeryUniversity of Texas Southwestern Medical CenterDallasTexasUSA
| | - Anthony K. Ngoo
- Medical Service, Infectious Disease SectionVeterans Affairs North Texas Health Care SystemDallasTexasUSA
| | - Shirling Tsai
- Surgical Service, Vascular SectionVeterans Affairs North Texas Health Care SystemDallasTexasUSA
- Department of Surgery, Division of Vascular & Endovascular SurgeryUniversity of Texas Southwestern Medical CenterDallasTexasUSA
| | - Anna K. Yang
- Foundation Foot & Ankle CenterNapervilleIllinoisUSA
| | - Dane K. Wukich
- Department of Orthopaedic SurgeryUniversity of Texas Southwestern Medical CenterDallasTexasUSA
| | - Lawrence A. Lavery
- Department of Orthopaedic SurgeryUniversity of Texas Southwestern Medical CenterDallasTexasUSA
- Department of Plastic SurgeryUniversity of Texas Southwestern Medical CenterDallasTexasUSA
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Bruening DA, Huber SC, Parry DJ, Hillier AR, Hayward AEM, Grover JK. The effect of existing and novel walker boot designs on offloading and gait mechanics. Med Eng Phys 2022; 108:103890. [DOI: 10.1016/j.medengphy.2022.103890] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2022] [Revised: 08/13/2022] [Accepted: 09/01/2022] [Indexed: 10/14/2022]
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Winkler E, Schöni M, Krähenbühl N, Uçkay I, Waibel FWA. Foot Osteomyelitis Location and Rates of Primary or Secondary Major Amputations in Patients With Diabetes. Foot Ankle Int 2022; 43:957-967. [PMID: 35582923 PMCID: PMC9260474 DOI: 10.1177/10711007221088552] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND Diabetic foot osteomyelitis (DFO) often leads to amputations in the lower extremity. Data on the influence of the initial anatomical DFO localization on ultimate major amputation are limited. METHODS In this retrospective analysis, 583 amputation episodes in 344 patients (78 females, 266 males) were analyzed. All received a form of amputation in combination with antibiotic therapy. A multivariate logistic regression analysis with the primary outcome "major amputation" defined as an amputation above the ankle joint was performed. The association of risk factors including location of DFO, coronary artery disease, peripheral artery disease, neuropathy, nephropathy, and Charcot neuro-osteoarthropathy was analyzed. RESULTS Among 583 episodes, DFO was located in the forefoot in 512 (87.8%), in the midfoot in 43 (7.4%), and in the hindfoot in 28 episodes (4.8%). Overall, 53 of 63 (84.1%) major amputations were performed because of DFO in the setting of peripheral artery disease as primary indication. Overall, limb loss occurred in 6.1% (31/512) of forefoot, 20.9% (9/43) of midfoot, and 46.4% (13/28) of hindfoot DFO. Among these, 22 (41.5%) were performed as the primary treatment, whereas 31 (58.5%) followed previously failed minor amputations. Among this latter group of secondary major amputations, the DFO was localized to the forefoot in 23 of 583 (3.9%), the midfoot in 4 of 583 (0.7%) and the hindfoot in 4 of 583 (0.7%). In multivariate logistic regression analysis, initial hindfoot localization was a significant factor (P < .05), whereas peripheral artery disease, smoking, and a midfoot DFO were not found to be risk factors. CONCLUSION In our retrospective series, the frequency of limb loss in DFO increased with more proximal initial foot DFO lesions, with almost half of patients losing their limbs with a hindfoot DFO. LEVEL OF EVIDENCE Level IV, retrospective cohort study.
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Affiliation(s)
- Elin Winkler
- Department of Orthopedics, Balgrist
University Hospital, University of Zurich, Zurich, Switzerland,Elin Winkler, MD, Department of
Orthopedics, Balgrist University Hospital, Forchstrasse 340, Zürich, 8008,
Switzerland.
| | - Madlaina Schöni
- Department of Orthopedics, Balgrist
University Hospital, University of Zurich, Zurich, Switzerland
| | - Nicola Krähenbühl
- Department of Orthopedics, Balgrist
University Hospital, University of Zurich, Zurich, Switzerland
| | - Ilker Uçkay
- Infectiology, Unit for Clinical and
Applied Research and Infectiology, Balgrist University Hospital, Zurich,
Switzerland
| | - Felix W. A. Waibel
- Department of Orthopedics, Balgrist
University Hospital, University of Zurich, Zurich, Switzerland
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Bedriñana-Marañón B, Rubio-Rodríguez M, Yovera-Aldana M, Garcia-Villasante E, Pinedo-Torres I. Association Between the Diabetes mellitus Duration and the Severity of Diabetic Foot Disease in Hospitalized Patients in Latin America. INT J LOW EXTR WOUND 2021:15347346211063266. [PMID: 34889665 DOI: 10.1177/15347346211063266] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Abstract
The objective was to determine the association between a diabetes mellitus duration greater than 10 years and the severity of diabetic foot in hospitalized patients in Latin America.Analytical, observational, and retrospective study based in secondary databases. Patients older than 18 years with diagnosis of diabetes mellitus (DM) and hospitalized for any causes were included. The independent and dependent variables were having more than 10 years of diagnosis of DM and the severity of the diabetic foot disease (Wagner> = 2), respectively. A crude Poisson regression analysis was performed to obtain prevalence rates adjusted to confounders.Male gender was 54.8% and the median age was 62 years. In the group with more than10 years of disease (n = 903) 18% (n = 162) had severe injuries. We performed two Poisson regression analyzes, one of which included the entire sample; and in the other, only patients with some degree of ulcer were included at the time of evaluation (Wagner > = 1). In the first analysis the PR was 1.95 (p < 0.01) adjusted for the significant variables in the bivariate analysis and in the second analysis the PR was 1.18 (p < 0.01) adding to the adjustment the days of injury prior to hospitalization and the location of the ulcer.We conclude that in patients with more than 10 years of diabetes mellitus, diabetic foot injuries are more severe, regardless type of diabetes, gender, age, history of amputation and days of injury prior to hospitalization for inpatients in Latin America.
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Affiliation(s)
| | | | - Marlon Yovera-Aldana
- Grupo de Investigación Neurociencia, Efectividad y Salud Pública, Universidad Científica del Sur, Lima, Perú
- 33209Red de Eficacia Clinica y Sanitaria, REDECS, Lima, Perú
| | - Eilhart Garcia-Villasante
- 33209Red de Eficacia Clinica y Sanitaria, REDECS, Lima, Perú
- 269034Hospital Nacional Daniel Alcides Carrion, Callao, Perú
| | - Isabel Pinedo-Torres
- Grupo de Investigación Neurociencia, Efectividad y Salud Pública, Universidad Científica del Sur, Lima, Perú
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Schofield H, Haycocks S, Robinson A, Edmonds M, Anderson SG, Heald AH. Mortality in 98 type 1 diabetes mellitus and type 2 diabetes mellitus: Foot ulcer location is an independent risk determinant. Diabet Med 2021; 38:e14568. [PMID: 33772856 DOI: 10.1111/dme.14568] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/04/2020] [Revised: 02/18/2021] [Accepted: 03/24/2021] [Indexed: 01/01/2023]
Abstract
INTRODUCTION We previously demonstrated in both a longitudinal study and in meta-analysis (pooled relative-risk RR, 2.45) that all-cause mortality is significantly higher in people with diabetes foot ulceration (DFU) than with those without a foot ulcer. In this prospective study, we looked at the factors linked to mortality after presentation to podiatry with DFU. METHODS Ninety-eight individuals recruited consecutively from the Salford Royal Hospital Multidisciplinary Foot Clinic in Spring 2016 were followed up for up to 48 months. Data concerning health outcomes were extracted from the electronic patient record (EPR). RESULTS Seventeen people (17) had type 1 diabetes mellitus, and 81 had type 2 diabetes mellitus. Thirty-one were women. The mean age (range) was 63.6 (28-90) years with maximum diabetes duration 45 years. Mean HbA1c was 72 (95% CI: 67-77) mmol/mol; 97% had neuropathy (International Working Group on the Diabetic Foot (IWGDF) monofilament); 62% had vascular insufficiency (Doppler studies); 69% of ulcers were forefoot, and 23% of ulcers were hind foot in location. Forty of 98 (40%) patients died in follow-up with 27% of death certificates including sepsis (not foot-related) and 35% renal failure as cause of death. Multivariate regression analysis indicated a 6.3 (95% CI: 3.9-8.1) fold increased risk of death with hind foot ulcer, independent of age/BMI/gender/HbA1c/eGFR/total cholesterol level. CONCLUSION This prospective study has indicated a very high long-term mortality rate in individuals with DFU, greater for those with a hind foot ulcer and shown a close relation between risk of sepsis/renal failure and DFU mortality, highlighting again the importance of addressing all risk factors as soon as people present with a foot ulcer.
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Affiliation(s)
| | | | - Adam Robinson
- Department of Diabetes and Endocrinology, Salford Royal Hospital, Salford, UK
| | | | - Simon G Anderson
- University of the West Indies, Cavehill Campus Barbados, Barbados, UK
| | - Adrian H Heald
- Department of Diabetes and Endocrinology, Salford Royal Hospital, Salford, UK
- School of Medicine and Manchester Academic Health Sciences Centre, University of Manchester, Manchester, UK
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Moon KC, Son JW, Han SK, Kim JY. Risk Factors for Major Amputation for Midfoot Ulcers in Hospitalized Patients With Diabetes: A Retrospective Study. J Wound Ostomy Continence Nurs 2021; 48:163-168. [PMID: 33690250 DOI: 10.1097/won.0000000000000735] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Abstract
PURPOSE The purpose of this study was to investigate the risk factors for major amputation in persons hospitalized with diabetic foot ulcers involving the midfoot. DESIGN Retrospective study. SUBJECTS AND SETTING Between January 2003 and May 2019, a total of 1931 patients with diabetes were admitted to the diabetic wound center for the management of foot ulcers. Among the admitted patients, 169 patients with midfoot ulcers were included in this study. One hundred fifty-four patients (91%) healed without major amputation, while 15 patients (9%) healed post-major amputation. METHODS Data related to 88 potential risk factors including demographics, ulcer condition, vascularity, bioburden, neurology, and serology were collected from patients in these 2 groups for comparison. Univariate and multivariate logistic regression analyses were performed to analyze risk factors for major amputation. RESULTS Among the 88 potential risk factors, 15 showed statistically significant differences between the 2 groups. Using univariate analysis of 88 potential risk factors, 8 showed statistically significant differences. Using stepwise multiple logistic regression analysis, 3 of the 8 risk factors remained statistically significant. Multivariate-adjusted odds ratios for deep ulcers invading bone, cardiac disorders, and Charcot foot were 26.718, 18.739, and 16.997, respectively. CONCLUSION The risk factors for major amputation in patients hospitalized with diabetic midfoot ulcers included deep ulcers invading the bone, cardiac disorders, and Charcot foot.
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Affiliation(s)
- Kyung-Chul Moon
- Kyung-Chul Moon, MD, PhD, Department of Plastic Surgery and Diabetic Wound Center, Korea University Guro Hospital, Seoul, South Korea.,Ji-Won Son, RN, WOCN, Department of Nursing Service and Diabetic Wound Center, Korea University Guro Hospital, Seoul, South Korea.,Seung-Kyu Han, MD, PhD, Department of Plastic Surgery and Diabetic Wound Center, Korea University Guro Hospital, Seoul, South Korea.,Jae-Yeon Kim, RN, WOCN, Department of Nursing Service and Diabetic Wound Center, Korea University Guro Hospital, Seoul, South Korea
| | - Ji-Won Son
- Kyung-Chul Moon, MD, PhD, Department of Plastic Surgery and Diabetic Wound Center, Korea University Guro Hospital, Seoul, South Korea.,Ji-Won Son, RN, WOCN, Department of Nursing Service and Diabetic Wound Center, Korea University Guro Hospital, Seoul, South Korea.,Seung-Kyu Han, MD, PhD, Department of Plastic Surgery and Diabetic Wound Center, Korea University Guro Hospital, Seoul, South Korea.,Jae-Yeon Kim, RN, WOCN, Department of Nursing Service and Diabetic Wound Center, Korea University Guro Hospital, Seoul, South Korea
| | - Seung-Kyu Han
- Kyung-Chul Moon, MD, PhD, Department of Plastic Surgery and Diabetic Wound Center, Korea University Guro Hospital, Seoul, South Korea.,Ji-Won Son, RN, WOCN, Department of Nursing Service and Diabetic Wound Center, Korea University Guro Hospital, Seoul, South Korea.,Seung-Kyu Han, MD, PhD, Department of Plastic Surgery and Diabetic Wound Center, Korea University Guro Hospital, Seoul, South Korea.,Jae-Yeon Kim, RN, WOCN, Department of Nursing Service and Diabetic Wound Center, Korea University Guro Hospital, Seoul, South Korea
| | - Jae-Yeon Kim
- Kyung-Chul Moon, MD, PhD, Department of Plastic Surgery and Diabetic Wound Center, Korea University Guro Hospital, Seoul, South Korea.,Ji-Won Son, RN, WOCN, Department of Nursing Service and Diabetic Wound Center, Korea University Guro Hospital, Seoul, South Korea.,Seung-Kyu Han, MD, PhD, Department of Plastic Surgery and Diabetic Wound Center, Korea University Guro Hospital, Seoul, South Korea.,Jae-Yeon Kim, RN, WOCN, Department of Nursing Service and Diabetic Wound Center, Korea University Guro Hospital, Seoul, South Korea
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Lu Q, Wang J, Wei X, Wang G, Xu Y. Risk Factors for Major Amputation in Diabetic Foot Ulcer Patients. Diabetes Metab Syndr Obes 2021; 14:2019-2027. [PMID: 33976562 PMCID: PMC8106455 DOI: 10.2147/dmso.s307815] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/22/2021] [Accepted: 03/25/2021] [Indexed: 01/22/2023] Open
Abstract
BACKGROUND The purpose of our study was to identify the new and the more specific risk factors for major amputation in patients with diabetic foot ulcer (DFU). METHODS We used data from the Electronic Medical Record (EMR) database of our hospital from February 2014 to July 2020. Patients with DFU and amputation were included in the study. The logistic regression model was adjusted for demographic characteristics and related comorbidities between major and minor amputation groups. RESULTS Among 3654 patients with DFU, 363 (9.9%) were amputated. Patients with major versus minor amputation, in multivariable logistic regression models, major amputation independent factors included previous amputation history (odds ratio [OR] 2.31 [95% CI 1.17-4.53], p = 0.02), smoking (2.58 [1.31-5.07], p = 0.01), coronary artery disease (CAD) (2.67 [1.35-5.29], p = 0.03), ankle brachial index (ABI) <0.4 (15.77 [7.51-33.13], p < 0.01), Wagner 5 (5.50 [1.89-16.01], p < 0.01), activated partial thromboplastin time (APTT) (1.23 [1.03-1.48], p = 0.01), glycosylated hemoglobin A1c (HbA1c) (1.23 [1.03-1.48], p = 0.03), hemoglobin (Hb) (0.98 [0.96-1.00], p = 0.01), plasma albumin (ALB) (0.88 [0.81-0.95], p < 0.01) and white blood cell (WBC) (1.10 [1.04-1.16], p < 0.01). CONCLUSION Major amputation was associated with previous amputation history, smoking, CAD, Wagner 5, ABI <0.4, HbA1c, Hb, ALB, WBC, and APTT might be a new independent factor. In view of these factors, early prevention and guidance promptly orientated by multidisciplinary is of great significance to reduce the disability rate and economic burden.
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Affiliation(s)
- Qingwei Lu
- Department of Ulcers and Peripheral Vascular Surgery, First Teaching Hospital of Tianjin University of Traditional Chinese Medicine, National Clinical Research Center for Chinese Medicine Acupuncture and Moxibustion, Tianjin, 300193, People’s Republic of China
| | - Jun Wang
- Department of Ulcers and Peripheral Vascular Surgery, First Teaching Hospital of Tianjin University of Traditional Chinese Medicine, National Clinical Research Center for Chinese Medicine Acupuncture and Moxibustion, Tianjin, 300193, People’s Republic of China
- Correspondence: Jun Wang; Gang Wang Department of Ulcers and Peripheral Vascular Surgery, First Teaching Hospital of Tianjin University of Traditional Chinese Medicine, National Clinical Research Center for Chinese Medicine Acupuncture and Moxibustion, Tianjin, 300000, People’s Republic of China Email ;
| | - Xiaolu Wei
- School of Integrated Traditional Chinese and Western Medicine, Binzhou Medical University, Yantai, 264003, People’s Republic of China
| | - Gang Wang
- Department of Ulcers and Peripheral Vascular Surgery, First Teaching Hospital of Tianjin University of Traditional Chinese Medicine, National Clinical Research Center for Chinese Medicine Acupuncture and Moxibustion, Tianjin, 300193, People’s Republic of China
| | - Yang Xu
- Department of Ulcers and Peripheral Vascular Surgery, First Teaching Hospital of Tianjin University of Traditional Chinese Medicine, National Clinical Research Center for Chinese Medicine Acupuncture and Moxibustion, Tianjin, 300193, People’s Republic of China
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