Department of Infectious Diseases and Clinical Microbiology, Izmir Katip Celebi University Ataturk Training and Research Hospital, Izmir, Turkey.
Department of Biostatistics, Izmir Katip Celebi University School of Medicine, Izmir, Turkey.
Diabetes Metab Res Rev. 2019 Oct;35(7):e3165. doi: 10.1002/dmrr.3165. Epub 2019 May 6.
Knowledge of risk factors is crucial to develop management and treatment protocols for the prevention of lower extremity amputation for patients with diabetic foot infections (DFIs).
We searched the research literature for studies reporting risk factors for lower extremity amputation in patients with DFI. The main outcome variables included both minor and major amputations. This study was reported in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) guidelines, and the protocol was registered in PROSPERO (CRD42018118543).
A total of 2471 potential articles from the database search met the inclusion criteria. After reviewing the titles, abstracts, and full texts, remaining 25 articles were included in the final analysis. We identified 6132 patients with DFI in the 25 included articles. Of these, 1873 patients who underwent amputation were investigated. Male gender (odds ratio [OR]: 1.31), smoking (OR: 1.38), history of amputation (OR: 1.47), history of osteomyelitis (OR: 1.94), peripheral arterial disease (OR: 2.35), retinopathy (OR: 1.32), International Working Group on the Diabetic Foot (IWGDF) grades 3 and 4 (OR: 1.7 and 2.5), Wagner grades 4 and 5 (OR: 4.3 and 6.4), gangrene/necrosis (OR: 9.9), osteomyelitis (OR: 4.5), neuroischaemic DFI (OR: 3.06), severe infection (OR: 3.12), length of hospitalization (standardized mean difference [SMD]: 0.7), leukocytosis (OR: 1.76), mean erythrocyte sedimentation rate (ESR) (SMD: 0.5), mean C-reactive protein (CRP) (SMD: 0.8), tissue culture positivity (OR: 1.61), and isolation of Gram-negative bacteria from tissue culture (OR: 1.5) were found as predictors of amputation in DFI.
The present study highlighted some differences in diabetic foot ulcers and DFIs in terms of risk factors for lower extremity amputation. These data provide detailed information about risk factors for amputations among patients with DFI, thus contributing to the creation of new classification systems for assessment of high-risk patients.
了解风险因素对于制定糖尿病足感染（DFI）患者下肢截肢的管理和治疗方案至关重要。
我们检索了报告 DFI 患者下肢截肢风险因素的研究文献。主要结局变量包括小截肢和大截肢。本研究按照系统评价和荟萃分析的首选报告项目（PRISMA）指南进行报告，并在 PROSPERO（CRD42018118543）中进行了注册。
从数据库搜索中共有 2471 篇潜在文章符合纳入标准。在审查了标题、摘要和全文后，最终有 25 篇文章纳入了最终分析。我们在 25 篇纳入的文章中确定了 6132 例 DFI 患者。其中，1873 例患者接受了截肢手术。男性（优势比 [OR]：1.31）、吸烟（OR：1.38）、截肢史（OR：1.47）、骨髓炎史（OR：1.94）、外周动脉疾病（OR：2.35）、视网膜病变（OR：1.32）、国际糖尿病足工作组（IWGDF）分级 3 和 4（OR：1.7 和 2.5）、Wagner 分级 4 和 5（OR：4.3 和 6.4）、坏疽/坏死（OR：9.9）、骨髓炎（OR：4.5）、神经缺血性 DFI（OR：3.06）、严重感染（OR：3.12）、住院时间（标准化均数差 [SMD]：0.7）、白细胞增多（OR：1.76）、平均红细胞沉降率（ESR）（SMD：0.5）、平均 C 反应蛋白（CRP）（SMD：0.8）、组织培养阳性（OR：1.61）和组织培养中革兰氏阴性菌的分离（OR：1.5）被发现是 DFI 下肢截肢的预测因素。
本研究强调了糖尿病足溃疡和 DFI 在下肢截肢风险因素方面的一些差异。这些数据提供了有关 DFI 患者截肢风险因素的详细信息，从而有助于为高危患者的评估创建新的分类系统。
