Hambleton Ian R, Jonnalagadda Ramesh, Davis Christopher R, Fraser Henry S, Chaturvedi Nish, Hennis Anselm J
Chronic Disease Research Centre, Tropical Medicine Research Institute, University of the West Indies, Barbados.
Diabetes Care. 2009 Feb;32(2):306-7. doi: 10.2337/dc08-1504. Epub 2008 Nov 4.
To determine the mortality rate after diabetes-related lower-extremity amputation (LEA) in an African-descent Caribbean population.
We conducted a prospective case-control study. We recruited case subjects (with diabetes and LEA) and age-matched control subjects (with diabetes and no LEA) between 1999 and 2001. We followed these groups for 5 years to assess mortality risk and causes.
There were 205 amputations (123 minor and 82 major). The 1-year and 5-year survival rates were 69 and 44% among case subjects and 97 and 82% among control subjects (case-control difference, P < 0.001). The mortality rates (per 1,000 person-years) were 273.9 (95% CI 207.1-362.3) after a major amputation, 113.4 (85.2-150.9) after a minor amputation, and 36.4 (25.6-51.8) among control subjects. Sepsis and cardiac disease were the most common causes of death.
These mortality rates are the highest reported worldwide. Interventions to limit sepsis and complications from cardiac disease offer a huge potential for improving post-LEA survival in this vulnerable group.
确定非洲裔加勒比人群中糖尿病相关下肢截肢（LEA）后的死亡率。
我们开展了一项前瞻性病例对照研究。在1999年至2001年期间，我们招募了病例受试者（患有糖尿病且接受了LEA）和年龄匹配的对照受试者（患有糖尿病但未接受LEA）。我们对这些组进行了5年的随访，以评估死亡风险和原因。
共进行了205例截肢手术（123例小截肢和82例大截肢）。病例受试者的1年和5年生存率分别为69%和44%，对照受试者分别为97%和82%（病例对照差异，P<0.001）。大截肢后的死亡率（每1000人年）为273.9（95%CI 207.1 - 362.3），小截肢后为113.4（85.2 - 150.9），对照受试者为36.4（25.6 - 51.8）。败血症和心脏病是最常见的死亡原因。
这些死亡率是全球报道的最高值。限制败血症和心脏病并发症的干预措施对于改善这一弱势群体LEA后的生存率具有巨大潜力。
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