Lee Jun Ho, Yoon Ji Sung, Lee Hyoung Woo, Won Kyu Chang, Moon Jun Sung, Chung Seung Min, Lee Yin Young
Republic of Korea Army, Hwacheon, Korea.
Division of Endocrinology and Metabolism, Department of Internal Medicine, Yeungnam University College of Medicine, Daegu, Korea.
Yeungnam Univ J Med. 2020 Oct;37(4):314-320. doi: 10.12701/yujm.2020.00129. Epub 2020 May 6.
A diabetic foot is the most common cause of non-traumatic lower extremity amputations (LEA). The study seeks to assess the risk factors of amputation in patients with diabetic foot ulcers (DFU).
The study was conducted on 351 patients with DFUs from January 2010 to December 2018. Their demographic characteristics, disease history, laboratory data, ankle-brachial index, Wagner classification, osteomyelitis, sarcopenia index, and ulcer sizes were considered as variables to predict outcome. A chi-square test and multivariate logistic regression analysis were performed to test the relationship of the data gathered. Additionally, the subjects were divided into two groups based on their amputation surgery.
Out of the 351 subjects, 170 required LEA. The mean age of the subjects was 61 years and the mean duration of diabetes was 15 years; there was no significant difference between the two groups in terms of these averages. Osteomyelitis (hazard ratio [HR], 6.164; 95% confidence interval [CI], 3.561-10.671), lesion on percutaneous transluminal angioplasty (HR, 2.494; 95% CI, 1.087-5.721), estimated glomerular filtration rate (eGFR; HR, 0.99; 95% CI, 0.981-0.999), ulcer size (HR, 1.247; 95% CI, 1.107-1.405), and forefoot ulcer location (HR, 2.475; 95% CI, 0.224-0.73) were associated with risk of amputation.
Osteomyelitis, peripheral artery disease, chronic kidney disease, ulcer size, and forefoot ulcer location were risk factors for amputation in diabetic foot patients. Further investigation would contribute to the establishment of a diabetic foot risk stratification system for Koreans, allowing for optimal individualized treatment.
糖尿病足是非创伤性下肢截肢（LEA）最常见的原因。本研究旨在评估糖尿病足溃疡（DFU）患者截肢的危险因素。
本研究对2010年1月至2018年12月期间的351例DFU患者进行。他们的人口统计学特征、病史、实验室数据、踝肱指数、瓦格纳分级、骨髓炎、肌肉减少症指数和溃疡大小被视为预测结果的变量。进行卡方检验和多因素逻辑回归分析以检验所收集数据之间的关系。此外，根据截肢手术情况将受试者分为两组。
在351名受试者中，170人需要进行LEA。受试者的平均年龄为61岁，糖尿病平均病程为15年；两组在这些平均值方面无显著差异。骨髓炎（风险比[HR]，6.164；95%置信区间[CI]，3.561 - 10.671）、经皮腔内血管成形术病变（HR，2.494；95%CI，1.087 - 5.721）、估计肾小球滤过率（eGFR；HR，0.99；95%CI，0.981 - 0.999）、溃疡大小（HR，1.247；95%CI，1.107 - 1.405）和前足溃疡部位（HR，2.475；95%CI，0.224 - 0.73）与截肢风险相关。
骨髓炎、外周动脉疾病、慢性肾脏病、溃疡大小和前足溃疡部位是糖尿病足患者截肢的危险因素。进一步的研究将有助于建立针对韩国人的糖尿病足风险分层系统，从而实现最佳的个体化治疗。
