Division of Endocrinology, Diabetes and Metabolism, Department of Medicine, Bayero University, Kano, Nigeria.
Division of Endocrinology, Diabetes and Metabolism, Department of Medicine, Enugu State University of Science and Technology, Enugu, Nigeria.
PLoS One. 2019 Dec 17;14(12):e0226226. doi: 10.1371/journal.pone.0226226. eCollection 2019.
Diabetes is a life-long and debilitating disease that is fraught with both acute and chronic complications. Of particular concern to sufferers of the disease is the development of foot problems. These problems range from foot deformities to slowly healing or non-healing ulcers (that may necessitate amputation) and in the worst-case scenario, to death. Identification and prompt treatment of comorbid conditions, such as anemia may improve outcome in patients with diabetic foot ulcers (DFU). We determined the prevalence of anemia in Nigerians with DFU and its impact on disease outcome.
We prospectively followed 336 patients with diabetes hospitalized for DFU and managed by a multidisciplinary team until discharge or death. Demographic and diabetes-related information and ulcer characteristics were documented. We evaluated each patient for neuropathy, vasculopathy and medical co-morbidities. Relevant laboratory and imaging studies were performed. We present the results of the sub-group analysis of patients with anemia to determine its prevalence and impact on disease outcome in patients with DFU in the MEDFUN study.
Anemia was detected in 180(53.6%) subjects with 88(48.9%) of them requiring blood transfusion. Significant demographic and clinical determinants of anemia were ulcer duration more than one month prior to hospitalization (p<0.009), PAD (p<0.001) and presence of gangrene (p<0.001). The comorbid conditions that were significantly associated with anemia included proteinuria (p<0.003), osteomyelitis (p<0.006), moderate (p<0.002) as well as severe (p<0.001) vascular stenosis, history of stroke (p<0.014) and renal impairment (p<0.002). Anemia was significantly associated with poor wound healing (p<0.009), amputation (p<0.036) and risk of death (p<0.034).
We detected anemia in more than half of our cohort with DFU. We found significant association between anemia and poor wound healing, amputation and mortality among our studied subjects. Future studies should explore whether prompt correction of anemia in subjects hospitalized for DFU would improve outcome.
糖尿病是一种终身性疾病，会导致急性和慢性并发症，给患者带来极大的痛苦。糖尿病患者特别关注足部问题。这些问题从足部畸形到愈合缓慢或不愈合的溃疡（可能需要截肢），甚至在最坏的情况下，导致死亡。识别和及时治疗贫血等合并症可能会改善糖尿病足溃疡（DFU）患者的预后。我们确定了尼日利亚 DFU 患者贫血的患病率及其对疾病结局的影响。
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，直到出院或死亡。记录人口统计学和糖尿病相关信息以及溃疡特征。我们评估了每位患者的神经病变、血管病变和合并症。进行了相关的实验室和影像学研究。我们报告了 MEDFUN 研究中贫血亚组分析的结果，以确定其在 DFU 患者中的患病率及其对疾病结局的影响。
在 180 名（53.6%）患者中发现了贫血，其中 88 名（48.9%）需要输血。贫血的显著人口统计学和临床决定因素是溃疡在住院前一个月以上（p<0.009）、PAD（p<0.001）和坏疽（p<0.001）。与贫血显著相关的合并症包括蛋白尿（p<0.003）、骨髓炎（p<0.006）、中度（p<0.002）和重度（p<0.001）血管狭窄、中风史（p<0.014）和肾功能不全（p<0.002）。贫血与伤口愈合不良（p<0.009）、截肢（p<0.036）和死亡风险（p<0.034）显著相关。
我们在 DFU 患者的队列中发现了一半以上的贫血患者。我们发现贫血与我们研究对象的伤口愈合不良、截肢和死亡之间存在显著关联。未来的研究应探讨在因 DFU 住院的患者中及时纠正贫血是否会改善预后。
