Kurniawati Anita, Ismiarto Yoyos Dias, Hsu I-Lin
Dr. Hasan Sadikin Hospital Faculty of Medicine University Padjadjaran Department of Orthopaedics & Traumatology Bandung Indonesia.
National Cheng Kung University College of Medicine National Cheng Kung University Hospital Department of Emergency Medicine Tainan Taiwan.
J Acute Med. 2019 Jun 1;9(2):59-63. doi: 10.6705/j.jacme.201906_9(2).0003.
Infection and necrosis are common acute complications of diabetic foot ulcer (DFU). Amputation is the last resort treatment to control severe diabetic foot infection. Many risk factors for progression of infection that lead to amputation are disclosed. However, the prediction for the amputation necessity is clinically important to stratify risk and target intervention for limb salvage. Accordingly, this study investigates the predictive risk factors for amputation need in diabetic patients with foot ulcer.
We retrospectively studied the medical records of the DFU patients from January to December in 2017. The patients wereclassifi ed as the non-amputation and amputation groups. Patient characteristics, clinical features of vasculopathy and neuropathy (ankle brachial index [ABI] and monofilament test), and laboratory features (hemoglobin A1C [HbA1C], C-reactive protein [CRP], and white blood cell [WBC] counts) were analyzed, using the univariate and multivariate analyses.
Of the eligible 73 cases (age 41 to 76 years), 14 (19.2%) underwent lower limb amputation. Using the multivariate model, significate risk factors included low ABI (< 0.8; adjusted odds ratio [OR] = 17.9; = 0.003), the presence of neuropathy (adjusted OR = 5.6; = 0.005), and HbA1C > 8.0% (adjusted OR = 4.7; = 0.016).
Several predictors, such as vasculopathy, neuropathy, higher HbA1C and CRP, were associated with amputation necessities in DFU patients. Of note, the vasculopathy was found to be the most important powerful. Therefore, identification and correction of these predictors would improve the quality care and patient prognosis.
感染和坏死是糖尿病足溃疡（DFU）常见的急性并发症。截肢是控制严重糖尿病足感染的最终治疗手段。已揭示了许多导致截肢的感染进展危险因素。然而，对于截肢必要性的预测在临床上对于分层风险和针对肢体挽救进行靶向干预非常重要。因此，本研究调查了糖尿病足溃疡患者截肢需求的预测危险因素。
我们回顾性研究了2017年1月至12月DFU患者的病历。患者被分为非截肢组和截肢组。使用单因素和多因素分析方法，分析了患者特征、血管病变和神经病变的临床特征（踝臂指数[ABI]和单丝试验）以及实验室特征（糖化血红蛋白[HbA1C]、C反应蛋白[CRP]和白细胞[WBC]计数）。
在符合条件的73例患者（年龄41至76岁）中，14例（19.2%）接受了下肢截肢。使用多因素模型，显著的危险因素包括低ABI（<0.8；调整后的优势比[OR]=17.9；P=0.003）、存在神经病变（调整后的OR=5.6；P=0.005）以及HbA1C>8.0%（调整后的OR=4.7；P=0.016）。
血管病变、神经病变、较高的HbA1C和CRP等几个预测因素与DFU患者的截肢必要性相关。值得注意的是，血管病变被发现是最重要的因素。因此，识别和纠正这些预测因素将改善护理质量和患者预后。
