Department of Medicine, Federal Medical Center, Umuahia, Nigeria.
Enugu State University of Science and Technology, Enugu, Nigeria.
Endocr Regul. 2020 Jul 1;54(3):207-216. doi: 10.2478/enr-2020-0023.
The high amputation rates from diabetic foot ulcer (DFU) in Nigeria and prolonged hospitalization due to poor wound healing is a source of concern. Furthermore, factors that affect wound healing of DFUs have not yet been well studied in Nigeria, whereas knowing these factors could improve DFU outcomes. Therefore, the objective of this study was to determine the factors that are associated with the wound healing in patients hospitalized for DFU.
The Multi-Center Evaluation of Diabetic Foot Ulcer in Nigeria (MEDFUN) was an observational study involving 336 diabetic patients hospitalized for DFU and managed by a multi-disciplinary team until discharge or death. Demographic, clinical, and biochemical characteristics were documented. Test statistics used were chi square, t-test, univariate, and multivariate logistic regression. The study endpoints were ulcer healing, LEA, duration of hospitalization, and mortality. Here we present data on wound healing.
The mean ± SD age was 55.9±12.5 years. Univariate predictors of wound healing were ulcer duration more than 1 month prior to hospitalization (p<0.001), peripheral arterial disease (PAD) (p<0.001), foot gangrene (p<0.001), Ulcer grade ≥3 (p=0.002), proteinuria (p=0.005), anemia (p=0.009), renal impairment (p=0.021), glycated hemoglobin ≥7% (0.012), and osteomyelitis (p<0.001). On multivariate regression, osteomyelitis was the strongest independent predictor of wound healing after adjusting for all other variables (OR 0.035; 95% CI 0.004-0.332). This was followed by PAD (OR 0.093; 95% CI 0.028-0.311), ulcer duration >1 month (OR 0.109; 95% CI 0.030-0.395), anemia (OR 0.179; 95% CI 0.056-0.571).
Presence of osteomyelitis, duration of ulcer greater than 1 month, PAD, Wagner grade 3 or higher, proteinuria, presence of gangrene, anemia, renal impairment, and HbA1c ≥7% were the significant predictors of wound healing in patients hospitalized for DFU. Early identification and prompt attention to these factors in a diabetic foot wound might significantly improve healing and reduce adverse outcomes such as amputation and death.
在尼日利亚，糖尿病足溃疡（DFU）的高截肢率和因伤口愈合不良而导致的住院时间延长令人担忧。此外，在尼日利亚，DFU 伤口愈合的影响因素尚未得到很好的研究，而了解这些因素可能会改善 DFU 的结局。因此，本研究旨在确定与 DFU 住院患者伤口愈合相关的因素。
多中心尼日利亚糖尿病足溃疡评估（MEDFUN）是一项观察性研究，共纳入 336 例因 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、临床和生化特征。使用的检验统计数据包括卡方检验、t 检验、单变量和多变量逻辑回归。研究终点为溃疡愈合、LEA、住院时间和死亡率。这里我们介绍了关于伤口愈合的数据。
平均年龄±标准差为 55.9±12.5 岁。伤口愈合的单变量预测因素包括住院前溃疡持续时间超过 1 个月（p<0.001）、外周动脉疾病（PAD）（p<0.001）、足部坏疽（p<0.001）、溃疡分级≥3 级（p=0.002）、蛋白尿（p=0.005）、贫血（p=0.009）、肾功能不全（p=0.021）、糖化血红蛋白≥7%（0.012）和骨髓炎（p<0.001）。多变量回归分析调整所有其他变量后，骨髓炎是伤口愈合的最强独立预测因素（OR 0.035；95%CI 0.004-0.332）。其次是 PAD（OR 0.093；95%CI 0.028-0.311）、溃疡持续时间>1 个月（OR 0.109；95%CI 0.030-0.395）和贫血（OR 0.179；95%CI 0.056-0.571）。
骨髓炎、溃疡持续时间>1 个月、PAD、Wagner 分级 3 级或以上、蛋白尿、坏疽、贫血、肾功能不全和 HbA1c≥7%是 DFU 住院患者伤口愈合的显著预测因素。早期识别和及时关注糖尿病足伤口中的这些因素可能显著改善愈合并降低不良结局，如截肢和死亡。
