Korean J Intern Med.  2018 Sep;33(5):952-960. 10.3904/kjim.2016.165.

Depth and combined infection is important predictor of lower extremity amputations in hospitalized diabetic foot ulcer patients

Affiliations
  • 1Division of Endocrinology and Metabolism, Department of Internal Medicine, College of Medicine, St. Paul’s Hospital, The Catholic University of Korea, Seoul, Korea.
  • 2Department of Orthopedic Surgery, College of Medicine, St. Vincent’s Hospital, The Catholic University of Korea, Suwon, Korea.
  • 3Division of Endocrinology and Metabolism, Department of Internal Medicine, College of Medicine, St. Paul’s Hospital, The Catholic University of Korea, Seoul, Korea. leejm68@catholic.ac.kr

Abstract

BACKGROUND/AIMS
As the prevalence of diabetes mellitus and its complications increase rapidly, diabetic foot ulcers (DFUs), which are a major diabetic complication, are expected to increase. For prevention and effective treatment, it is important to understand the clinical course of DFUs. The aim of this study was to investigate the natural course and predictors of amputation in patients with DFUs who required hospitalization.
METHODS
A total of 209 patients with type 2 diabetes, aged 30 to 85 years, who visited emergency department or needed hospitalization due to DFUs were consecutively enrolled from May 2012 to January 2016, by retrospective medical record review. The main outcome was lower extremity amputation (LEA).
RESULTS
Among 192 patients who completed follow-up, 113 patients (58.9%) required LEAs. Compared to patients without amputation, baseline levels of white blood cell counts and C-reactive protein were higher in patients with amputation. In addition, bone and joint involvement was more frequently observed in patients with amputation. Multivariable regression analysis revealed that combined infection (odds ratio [OR], 11.39; 95% confidence interval [CI], 2.55 to 50.93; p = 0.001) and bone or joint involvement (OR, 3.74; 95% CI, 1.10 to 12.70; p = 0.035) were significantly associated with an increased risk of LEA.
CONCLUSIONS
The depth of the wound and combined infection of DFU, rather than the extent of the wound, were significant prognostic factors of LEAs in patients with type 2 diabetes.

Keyword

Diabetes mellitus; Diabetic foot; Ulcer; Prognosis; Amputation

MeSH Terms

Amputation*
C-Reactive Protein
Diabetes Complications
Diabetes Mellitus
Diabetic Foot*
Emergency Service, Hospital
Follow-Up Studies
Hospitalization
Humans
Joints
Leukocyte Count
Lower Extremity*
Medical Records
Prevalence
Prognosis
Retrospective Studies
Ulcer*
Wounds and Injuries
C-Reactive Protein
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