Francia Piergiorgio, Gualdani Elisa, Policardo Laura, Bocchi Leonardo, Franconi Flavia, Francesconi Paolo, Seghieri Giuseppe
Department of Information Engineering, University of Florence, 50139 Florence, Italy.
Epidemiology Unit, Agenzia Regionale Sanità, 50141 Florence, Italy.
J Clin Med. 2022 Apr 27;11(9):2454. doi: 10.3390/jcm11092454.
The aim of this study was to evaluate the risk of death after hospitalizations for diabetic foot (DF) complications, comparing two different cohorts of people with or without a prior history of DF hospitalizations across the years 2011 to 2018 in Tuscany, Italy. The DF complications were categorized by administrative source datasets such as: amputations (both major and minor), gangrene, ulcers, infections, Charcot and revascularizations. A further aim was to present the trend over time of the first ever incidents of diabetic foot hospitalizations in Tuscany. The eight-year-mortality rate was higher in the cohort with prior hospitalizations ( = 6633; 59%) compared with the cohort with first incident DF hospitalizations ( = 5028; 44%). Amputations (especially major ones) and ulcers had the worst effect on survival in people without basal history of DF hospitalizations and respectively in those with a history of prior DF hospitalizations. In both cohorts, revascularization procedures, when compared to ulcers, were associated with a significantly reduced risk of mortality. The prevalence rate of minor amputations showed a slightly rising trend over time. This result agrees with the national trend. Conversely, the progressive increase over time of revascularizations, associated with the fractional decrease in the rate of gangrene, suggests a trend for more proactive behavior by DF care teams in Tuscany.
本研究的目的是评估糖尿病足（DF）并发症住院后的死亡风险，比较2011年至2018年意大利托斯卡纳地区两组不同队列的人群，一组有DF住院史，另一组无DF住院史。DF并发症通过行政来源数据集进行分类，如：截肢（包括大截肢和小截肢）、坏疽、溃疡、感染、夏科氏关节病和血管重建术。另一个目的是呈现托斯卡纳地区首次发生DF住院事件的时间趋势。有既往住院史的队列（n = 6633；59%）的八年死亡率高于首次发生DF住院的队列（n = 5028；44%）。截肢（尤其是大截肢）和溃疡对无DF住院基础病史的人群以及有既往DF住院病史的人群的生存影响最严重。在两个队列中，与溃疡相比，血管重建术与显著降低的死亡风险相关。小截肢的患病率随时间呈轻微上升趋势。这一结果与全国趋势一致。相反，血管重建术随时间的逐渐增加，与坏疽发生率的相应下降相关，这表明托斯卡纳地区DF护理团队有更积极主动行为的趋势。
