1Department of Medicine, Division of Endocrinology, Diabetes and Metabolism, Enugu State University of Science and Technology, Enugu, Nigeria.
2Department of Medicine, Division of Endocrinology, Diabetes and Metabolism, Lagos State University, Lagos, Nigeria.
J Foot Ankle Res. 2019 Jun 14;12:34. doi: 10.1186/s13047-019-0345-y. eCollection 2019.
Lower extremity amputation (LEA) is a potential sequelae of diabetic foot ulceration (DFU) and is associated with huge morbidly and mortality. Low and middle income countries are currently at the greatest risk of diabetes-related complications and deaths. We sought to identify demographic, clinical and laboratory variables that significantly predict LEA in patients hospitalized for DFU.
The Multi-center Evaluation of Diabetic Foot Ulcer in Nigeria (MEDFUN) was an observational study conducted between March 2016 and April 2017 in six tertiary healthcare institutions. We prospectively followed 336 diabetic patients hospitalized for DFU and managed by a multidisciplinary team until discharge or death. Demographic and diabetes-related information and ulcer characteristics were documented. Patients were evaluated for neuropathy, peripheral arterial disease (PAD) and medical co-morbidities while relevant laboratory and imaging tests were performed. The study end-points were ulcer healing, LEA, duration of hospitalization and mortality. Here we present data on amputation.
One hundred and nineteen subjects (35.4%) underwent LEA during the follow-up period. Univariate predictors of LEA were ulcer duration more than 1 month prior to hospitalization ( < 0.001), PAD ( < 0.001), Wagner grade ≥ 4 ( < 0.001), wound infection (P 0.041), Proteinuria (P 0.021), leucocytosis (P 0.001) and osteomyelitis ( < 0.001). On multivariate regression, only three variables emerged as significant independent predictors of LEA and these include: ulcer duration more than 1 month (O.R. 10.3, 95% C.I. 4.055-26.132), PAD (O.R. 2.8, 95% C.I. 1.520-5.110) and presence of osteomyelitis (O.R. 5.6, 95% C.I. 2.930-10.776). Age, gender, diabetes type and duration, neuropathy, glycemic control and anemia did not predict LEA in the studied population.
We identified duration of ulcer greater than 1 month, PAD, Wagner grade 4 or higher, proteinuria, leucocytosis, wound infection and osteomyelitis as the significant predictors of LEA in patients hospitalized for DFU. Prompt attention to these risk factors may reduce amputation rate among these patients.
下肢截肢（LEA）是糖尿病足溃疡（DFU）的潜在后遗症，与巨大的发病率和死亡率相关。中低收入国家目前面临着糖尿病相关并发症和死亡的最大风险。我们旨在确定在因 DFU 住院的患者中，能显著预测 LEA 的人口统计学、临床和实验室变量。
多中心评估尼日利亚糖尿病足溃疡（MEDFUN）是一项于 2016 年 3 月至 2017 年 4 月期间在六家三级医疗机构进行的观察性研究。我们前瞻性地随访了 336 名因 DFU 住院并由多学科团队管理的糖尿病患者，直至出院或死亡。记录了人口统计学和糖尿病相关信息以及溃疡特征。对患者的神经病变、外周动脉疾病（PAD）和医疗合并症进行了评估，同时进行了相关的实验室和影像学检查。研究终点为溃疡愈合、LEA、住院时间和死亡率。在此，我们介绍关于截肢的数据。
在随访期间，有 119 名患者（35.4%）进行了 LEA。LEA 的单因素预测因子为住院前溃疡持续时间超过 1 个月（ < 0.001）、PAD（ < 0.001）、Wagner 分级 ≥ 4（ < 0.001）、伤口感染（P 0.041）、蛋白尿（P 0.021）、白细胞增多（P 0.001）和骨髓炎（ < 0.001）。多变量回归分析显示，只有三个变量是 LEA 的显著独立预测因子，包括：溃疡持续时间超过 1 个月（O.R. 10.3，95% C.I. 4.055-26.132）、PAD（O.R. 2.8，95% C.I. 1.520-5.110）和骨髓炎的存在（O.R. 5.6，95% C.I. 2.930-10.776）。在研究人群中，年龄、性别、糖尿病类型和持续时间、神经病变、血糖控制和贫血均不能预测 LEA。
我们发现溃疡持续时间超过 1 个月、PAD、Wagner 分级 4 或更高、蛋白尿、白细胞增多、伤口感染和骨髓炎是 DFU 住院患者 LEA 的显著预测因子。及时关注这些危险因素可能会降低这些患者的截肢率。
