Division of Endocrinology and Metabolism, Department of Internal Medicine, Dokuz Eylul University School, Inciralti, Izmir, Turkey.
Hormones (Athens). 2009 Oct-Dec;8(4):286-95. doi: 10.14310/horm.2002.1245.
Prediction of diabetic foot ulcer outcome may be helpful for clinicians in optimizing and individualizing management strategy. The aim of the present study was to examine the possibility of predicting the outcome of patients with diabetic foot ulcers by using easily assessed clinical and laboratory parameters at baseline.
In this observational study, data were collected prospectively in 670 consecutive diabetic foot ulcer episodes in 510 patients examined between January 1999 and June 2008 and were used to evaluate potential predictors of amputation retrospectively. After exclusion of patients who did not come to the hospital for follow-up for a minimum of six months, data of 574 foot ulcer episodes were evaluated.
Limb ischemia, osteomyelitis and presence of gangrene and ulcer depth, determined by the Wagner classification system, were the major independent predictors of overall and major amputations. Older age, presence of coronary artery disease, smoking and ulcer size were found to be associated with either overall or major amputations. Baseline levels of acute phase reactants (white blood cell count, polymorphonuclear leukocyte count, platelet count, erythrocyte sedimentation rate (ESR), serum C-reactive protein (CRP) and albumin) and decreased hemoglobin levels were associated with amputation risk. Multivariate analysis showed that one standard deviation increase in baseline CRP and ESR levels were independent predictors of overall and major amputations, respectively.
The presence of limb ischemia, osteomyelitis, local and diffuse gangrene and ulcer depth were independent predictors of amputation. Baseline levels of ESR and CRP appeared to be helpful for clinicians in predicting amputation.
预测糖尿病足溃疡的结局有助于临床医生优化和个体化管理策略。本研究旨在探讨能否通过基线时易于评估的临床和实验室参数来预测糖尿病足溃疡患者的结局。
在这项观察性研究中，前瞻性地收集了 510 例患者的 670 例连续糖尿病足溃疡病例的数据，这些患者于 1999 年 1 月至 2008 年 6 月期间接受了检查，用于回顾性评估潜在的截肢预测因素。排除至少 6 个月未因随访而到医院就诊的患者后，评估了 574 例足溃疡病例的数据。
肢体缺血、骨髓炎和存在坏疽以及溃疡深度（根据 Wagner 分类系统确定）是总体和主要截肢的主要独立预测因素。年龄较大、存在冠心病、吸烟以及溃疡大小与总体或主要截肢有关。基线时急性期反应物（白细胞计数、中性粒细胞计数、血小板计数、红细胞沉降率（ESR）、血清 C 反应蛋白（CRP）和白蛋白）水平和血红蛋白水平降低与截肢风险相关。多变量分析显示，基线 CRP 和 ESR 水平增加一个标准差分别是总体和主要截肢的独立预测因素。
肢体缺血、骨髓炎、局部和弥漫性坏疽以及溃疡深度是截肢的独立预测因素。ESR 和 CRP 的基线水平似乎有助于临床医生预测截肢。
