Meloni Marco, Bouillet Benjamin, Ahluwalia Raju, Sanchez-Rios Juan Pedro, Iacopi Elisabetta, Izzo Valentina, Manu Chris, Julien Vouillarmet, Luedmann Claas, Garcia-Klepzig José Luis, Guillaumat Jérome, Lazaro-Martinez Jose Luis
Diabetic Foot Unit, Department of System Medicine, University of Rome Tor Vergata, 00133 Rome, Italy.
Endocrinology Department, University Hospital Center, 21000 Dijon, France.
J Clin Med. 2023 Jan 18;12(3):761. doi: 10.3390/jcm12030761.
This study aimed to validate the association between the grades of severity of diabetic foot ulcers (DFUs) identified by the fast-tack model and specific outcomes. Three hundred and sixty-seven patients with new DFUs who were referred to a tertiary level diabetic foot service serving Rome, Italy, were included. The fast-track model identifies three levels of DFUs' severity: uncomplicated DFUs, including superficial wounds, not-infected wounds, and not-ischemic wounds; complicated DFUs, including ischemic wounds, infected wounds, and deep ulcers involving the muscles, tendons, or bones, and any kind of ulcers in patients on dialysis and/or with heart failure; and severely complicated DFUs, including abscesses, wet gangrene, necrotizing fasciitis, fever, or clinical signs of sepsis. Healing, minor and major amputation, hospitalization, and survival after 24 weeks of follow-up were considered. Among the included patients, 35 (9.6%) had uncomplicated DFUs, 210 (57.2%) had complicated DFUs, and 122 (33.2%) had severely complicated DFUs. The outcomes for patients with uncomplicated, complicated, and severely complicated DFUs were as follows, respectively: healing, 97.1%, 86.2%, and 69.8%; minor amputation, 2.9%, 20%, and 66.4%; major amputation, 0%, 2.9%, and 16.4%; hospitalization, 14.3%, 55.7%, and 89.3%; survival, 100%, 96.7%, and 89.3%. DFU severity was an independent predictor of healing, amputation, hospitalization, and survival. The current study shows an association between the grade of severity of DFUs identified by the fast-track model and the considered outcomes. The fast-track model may be a useful tool for assessing the severity and prognosis of DFUs.
本研究旨在验证快速评估模型所确定的糖尿病足溃疡（DFU）严重程度分级与特定结局之间的关联。纳入了367例新诊断为DFU并转诊至意大利罗马一家三级糖尿病足诊疗机构的患者。快速评估模型将DFU严重程度分为三个等级：单纯性DFU，包括浅表伤口、未感染伤口和非缺血性伤口；复杂性DFU，包括缺血性伤口、感染伤口以及累及肌肉、肌腱或骨骼的深部溃疡，以及透析和/或心力衰竭患者的任何类型溃疡；严重复杂性DFU，包括脓肿、湿性坏疽、坏死性筋膜炎、发热或脓毒症临床体征。研究考虑了愈合情况、小截肢和大截肢、住院情况以及随访24周后的生存率。在纳入的患者中，35例（9.6%）为单纯性DFU，210例（57.2%）为复杂性DFU，122例（33.2%）为严重复杂性DFU。单纯性、复杂性和严重复杂性DFU患者的结局分别如下：愈合率分别为97.1%、86.2%和69.8%；小截肢率分别为2.9%、20%和66.4%；大截肢率分别为0%、2.9%和16.4%；住院率分别为14.3%、55.7%和89.3%；生存率分别为100%、96.7%和89.3%。DFU严重程度是愈合、截肢、住院和生存的独立预测因素。本研究表明，快速评估模型所确定的DFU严重程度分级与所考虑的结局之间存在关联。快速评估模型可能是评估DFU严重程度和预后的有用工具。
