Schofield Heather, Haycocks Samantha, Robinson Adam, Edmonds Michael, Anderson Simon G, Heald Adrian H
Department of Podiatry, Salford Royal Hospital, Salford, UK.
Department of Diabetes and Endocrinology, Salford Royal Hospital, Salford, UK.
Diabet Med. 2021 Oct;38(10):e14568. doi: 10.1111/dme.14568. Epub 2021 Jun 14.
We previously demonstrated in both a longitudinal study and in meta-analysis (pooled relative-risk RR, 2.45) that all-cause mortality is significantly higher in people with diabetes foot ulceration (DFU) than with those without a foot ulcer. In this prospective study, we looked at the factors linked to mortality after presentation to podiatry with DFU.
Ninety-eight individuals recruited consecutively from the Salford Royal Hospital Multidisciplinary Foot Clinic in Spring 2016 were followed up for up to 48 months. Data concerning health outcomes were extracted from the electronic patient record (EPR).
Seventeen people (17) had type 1 diabetes mellitus, and 81 had type 2 diabetes mellitus. Thirty-one were women. The mean age (range) was 63.6 (28-90) years with maximum diabetes duration 45 years. Mean HbA1c was 72 (95% CI: 67-77) mmol/mol; 97% had neuropathy (International Working Group on the Diabetic Foot (IWGDF) monofilament); 62% had vascular insufficiency (Doppler studies); 69% of ulcers were forefoot, and 23% of ulcers were hind foot in location. Forty of 98 (40%) patients died in follow-up with 27% of death certificates including sepsis (not foot-related) and 35% renal failure as cause of death. Multivariate regression analysis indicated a 6.3 (95% CI: 3.9-8.1) fold increased risk of death with hind foot ulcer, independent of age/BMI/gender/HbA1c/eGFR/total cholesterol level.
This prospective study has indicated a very high long-term mortality rate in individuals with DFU, greater for those with a hind foot ulcer and shown a close relation between risk of sepsis/renal failure and DFU mortality, highlighting again the importance of addressing all risk factors as soon as people present with a foot ulcer.
我们之前在一项纵向研究和荟萃分析（合并相对风险RR，2.45）中均证明，糖尿病足溃疡（DFU）患者的全因死亡率显著高于无足溃疡患者。在这项前瞻性研究中，我们探讨了DFU患者就诊于足病科后与死亡率相关的因素。
2016年春季从索尔福德皇家医院多学科足病诊所连续招募了98名个体，随访长达48个月。有关健康结局的数据从电子病历（EPR）中提取。
17人患有1型糖尿病，81人患有2型糖尿病。31人为女性。平均年龄（范围）为63.6（28 - 90）岁，糖尿病最长病程45年。平均糖化血红蛋白为72（95%可信区间：67 - 77）mmol/mol；97%有神经病变（糖尿病足国际工作组（IWGDF）单丝检查）；62%有血管功能不全（多普勒研究）；69%的溃疡位于前足，23%的溃疡位于后足。98名患者中有40名（40%）在随访中死亡，27%的死亡证明显示败血症（与足部无关）和35%的肾衰竭为死因。多变量回归分析表明，后足溃疡患者死亡风险增加6.3倍（95%可信区间：3.9 - 8.），独立于年龄/体重指数/性别/糖化血红蛋白/估算肾小球滤过率/总胆固醇水平。
这项前瞻性研究表明DFU患者的长期死亡率非常高，后足溃疡患者更高，并显示败血症/肾衰竭风险与DFU死亡率密切相关，再次强调了一旦患者出现足溃疡就应对所有风险因素进行处理的重要性。
