Iacopi Elisabetta, Pieruzzi Letizia, Riitano Nicola, Abbruzzese Lorenza, Goretti Chiara, Piaggesi Alberto
University of Pisa, Pisa, Italy.
Int J Low Extrem Wounds. 2023 Mar;22(1):19-26. doi: 10.1177/1534734620984604. Epub 2021 Jan 22.
We aimed to analyze sex-related differences in clinical outcomes among patients with diabetic foot disease (DFD) managed in a third-level referral center. We retrospectively analyzed data of admissions performed in our department between 2011 and 2015 for DFD. We collected demographic and clinical data, procedures performed during the admission, and short- and long-term outcomes in terms of healing rate and healing time, major amputation, and mortality rates during the follow-up. We focused on differences between genders and tried to figure out if sex could be considered a predictive factor. We collected data from 1237 admission performed in 842 patients (615 men [73%] and 227 women [27%]; age: 68.6 ± 27.9 years; diabetes duration: 16.4 ± 13.4 years; body mass index: 28.2 ± 6.4 kg/m; hemoglobin A1c 7.9 ± 1.9%). Men showed a higher prevalence of comorbidities and previous ulcers or revascularization procedures. Men had a significantly higher healing rate compared with women (85.4% vs 63.2%, < .001), but a longer healing time (124 ± 27 days vs 87 ± 14 days, = .02). Major amputation did not differ between groups, while mortality rate was significantly higher in men (24.5% vs 16.1%, = .02). In Cox's regression analysis, male sex was a positive predictive factor for healing and a negative one for time to heal and mortality. The difference in mortality was confirmed by a Kaplan-Meier analysis (log rank test: = .03). DFD represents a severe disease and a strong marker of mortality affecting more severely on clinical outcomes and survival on men.
我们旨在分析在三级转诊中心接受治疗的糖尿病足病（DFD）患者临床结局中的性别差异。我们回顾性分析了2011年至2015年间在我科因DFD住院的数据。我们收集了人口统计学和临床数据、住院期间进行的手术，以及随访期间的短期和长期结局，包括愈合率、愈合时间、大截肢率和死亡率。我们关注性别差异，并试图确定性别是否可被视为一个预测因素。我们收集了842例患者1237次住院的数据（615例男性[73%]和227例女性[27%]；年龄：68.6±27.9岁；糖尿病病程：16.4±13.4年；体重指数：28.2±6.4kg/m²；糖化血红蛋白7.9±1.9%）。男性合并症以及既往溃疡或血运重建手术的患病率更高。与女性相比，男性的愈合率显著更高（85.4%对63.2%，P<0.001），但愈合时间更长（124±27天对87±14天，P = 0.02）。两组间大截肢率无差异，而男性的死亡率显著更高（24.5%对16.1%，P = 0.02）。在Cox回归分析中，男性性别是愈合的阳性预测因素，是愈合时间和死亡率的阴性预测因素。Kaplan-Meier分析证实了死亡率的差异（对数秩检验：P = 0.03）。DFD是一种严重疾病，也是死亡率的一个重要指标，对男性的临床结局和生存影响更严重。
