Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania.
Abbas Medical Centre, Dar es Salaam, Tanzania.
Endocrinol Diabetes Metab. 2022 May;5(3):e00336. doi: 10.1002/edm2.336. Epub 2022 Apr 6.
This prospective cohort study aimed to identify the characteristics of patients with diabetic foot ulcer who are at higher risk of amputation and at increased risk of death.
About 103(M/F:60/43) participants, with active foot ulcer at baseline, participated in this study and followed for 22 years till death or lost to follow-up. Ten clinical measures were collected at baseline. During the follow-up of 4.2 ± 5.4 years, 22(M/F:14/8) participants had an amputation and 50(M/F:32/18) participants passed away during 5.5 ± 5.8 years follow-up period.
Cox Proportional Hazard regression (HR[95%CI]) indicated neuropathy (6.415[1.119-36.778]); peripheral arterial disease (PAD) (9.741[1.932- 49.109]); current smoking (16.148[1.658-157.308]); diabetes type- 1 (3.228[1.151-9.048]) and longer delay attending appointment after ulcer (1.013[1.003-1.023]) were significantly (p < .05) associated with increased risk of amputation. In addition, death was significantly associated with the risk of amputation (3.458[1.243-9.621]). Three parameters (HR[95%CI]) including neuropathy (3.058[1.297-7.210]); PAD (5.069[2.113-12.160]); amputation history (3.689[1.306-10.423]) and retinopathy (2.389[1.227-4.653]) were all significantly associated with increased risk of death. Kaplan-Meier survival analyses indicates that the time to amputation in years for participants who eventually died was significantly shorter (11.122 ± 1.507) vs those who stayed alive (15.427 ± 1.370).
Neuropathy and PAD were the only two characteristics that increased both the risk of amputation and death. Amputation showed to contribute to an increased risk of death and those participants who eventually died had a higher risk of amputation. Delay in attending appointments after ulceration is shown to increase the risk of amputation. In addition, the participants with PAD showed a significantly shorter time to both amputation and death while neuropathy was only associated with decreased time to death. Amputation history and death during follow-up decrease the time to death and amputation respectively.
本前瞻性队列研究旨在确定患有糖尿病足溃疡且截肢风险较高和死亡风险增加的患者的特征。
约 103 名（男/女：60/43）参与者在基线时有活动性足部溃疡，随访 22 年，直至死亡或失访。基线时收集了 10 项临床指标。在 4.2±5.4 年的随访期间，22 名（男/女：14/8）参与者进行了截肢，50 名（男/女：32/18）参与者在 5.5±5.8 年的随访期间死亡。
Cox 比例风险回归（HR[95%CI]）表明神经病变（6.415[1.119-36.778]）；外周动脉疾病（PAD）（9.741[1.932-49.109]）；当前吸烟（16.148[1.658-157.308]）；1 型糖尿病（3.228[1.151-9.048]）和溃疡后就诊时间延长（1.013[1.003-1.023]）与截肢风险增加显著相关（p<.05）。此外，死亡与截肢风险显著相关（3.458[1.243-9.621]）。三个参数（HR[95%CI]），包括神经病变（3.058[1.297-7.210]）；PAD（5.069[2.113-12.160]）；截肢史（3.689[1.306-10.423]）和视网膜病变（2.389[1.227-4.653]）与死亡风险增加均显著相关。Kaplan-Meier 生存分析表明，最终死亡患者的截肢时间（11.122±1.507 年）明显短于存活患者（15.427±1.370 年）。
神经病变和 PAD 是唯一同时增加截肢和死亡风险的两个特征。截肢增加了死亡风险，最终死亡的参与者截肢风险更高。溃疡后就诊时间延长会增加截肢风险。此外，PAD 患者的截肢和死亡时间均明显缩短，而神经病变仅与死亡时间缩短相关。截肢史和随访期间的死亡分别减少了死亡和截肢的时间。
