糖尿病足溃疡具有较高的截肢率和死亡率，尤其是在老年、存在外周动脉疾病和贫血的情况下。

Diabetic foot ulcer carries high amputation and mortality rates, particularly in the presence of advanced age, peripheral artery disease and anemia.

作者信息

Costa Rafael Henrique Rodrigues, Cardoso Natália Anício, Procópio Ricardo Jayme, Navarro Túlio Pinho, Dardik Alan, de Loiola Cisneros Ligia

机构信息

University Hospital, Federal University of Minas Gerais, Belo Horizonte, MG, Brazil.

Post-Graduate Program for Surgery and Ophthalmology, Faculty of Medicine, Federal University of Minas Gerais, Belo Horizonte, MG, Brazil.

出版信息

Diabetes Metab Syndr. 2017 Dec;11 Suppl 2:S583-S587. doi: 10.1016/j.dsx.2017.04.008. Epub 2017 Apr 12.

DOI:10.1016/j.dsx.2017.04.008

PMID:28465149

Abstract

INTRODUCTION

Foot ulcer is also a clinical marker for limb amputation and for death in diabetic patients. The purpose of this study was to determine amputation and mortality rates and its associated factors in patients with diabetic foot ulcerations in a tertiary hospital in Brazil.

METHODS

Retrospective medical records from 654 diabetic foot patients were reviewed. The risk factors were determined using the conditional logistic regression model analysis.

RESULTS

The mean patient age was 63.1 years (SD 12.20). Peripheral arterial disease was present in 160 patients (24.5%). Major amputations were performed in 135 (21%). The in-hospital mortality rate was 12% and the mortality rate of the amputees was 22.2%. The lowest hemoglobin level, the median value was 9.50g/dL, (4.0-17.0). Anemia was detected in 89.6% of patients submitted to amputation and in 82,1% of those who died. Hemoglobin <11g/dL was the most significant risk factor for major amputation (odds ratio 5.57, p<0.0001). The presence of peripheral arterial disease and old age were also a risk for major amputation (odds ratio 1.84, p=0.007 and 1.02, p=0.028, respectively). Factors associated with increased risk for death were hemoglobin <11g/dL (odds ratio 4.04, p<0.001), major amputation (1.79, p=0.03) and old age (1.05, p<0,001).

CONCLUSIONS

Diabetic foot ulcer is associated with high amputation and mortality rates. Old age, peripheral arterial disease and low hemoglobin level are risk factor for major amputation. Old age, major amputation and low hemoglobin level are risk factors for death.

摘要

引言

足部溃疡也是糖尿病患者肢体截肢和死亡的临床标志。本研究的目的是确定巴西一家三级医院中糖尿病足溃疡患者的截肢率和死亡率及其相关因素。

方法

回顾了654例糖尿病足患者的回顾性病历。使用条件逻辑回归模型分析确定危险因素。

结果

患者的平均年龄为63.1岁（标准差12.20）。160例患者（24.5%）存在外周动脉疾病。135例（21%）患者接受了大截肢手术。住院死亡率为12%，截肢患者的死亡率为22.2%。血红蛋白最低水平，中位数为9.50g/dL（4.0 - 17.0）。在接受截肢手术的患者中，89.6%检测出贫血，在死亡患者中这一比例为82.1%。血红蛋白<11g/dL是大截肢的最显著危险因素（优势比5.57，p<0.0001）。外周动脉疾病的存在和老年也是大截肢的危险因素（优势比分别为1.84，p = 0.007和1.02，p = 0.028）。与死亡风险增加相关的因素有血红蛋白<11g/dL（优势比4.04，p<0.001）、大截肢（1.79，p = 0.03）和老年（1.05，p<0.001）。