Shanghai University of Traditional Chinese Medicine, Shanghai, China.
Shanghai Traditional Chinese Medicine Integrated Hospital, Shanghai University of Traditional Chinese Medicine, Shanghai, China.
Int Wound J. 2023 Dec;20(10):4050-4060. doi: 10.1111/iwj.14296. Epub 2023 Jul 4.
Diabetic foot ulcer often leads to amputation, and both nutritional status and immune function have been associated with this process. We aimed to investigate the risk factors of diabetic ulcer-related amputation including the Controlling Nutritional Status score and neutrophil-to-lymphocyte ratio biomarker. We evaluated data from hospital in patients with diabetic foot ulcer, performing univariate and multivariate analyses to screen for high-risk factors and Kaplan-Meier analysis to correlate high-risk factors with amputation-free survival. Overall, 389 patients underwent 247 amputations over the follow-up period. After correction to relevant variables, we identified five independent risk factors for diabetic ulcer-related amputation: ulcer severity, ulcer site, peripheral arterial disease, neutrophil-to-lymphocyte ratio and nutritional status. Amputation-free survival was lower for the moderate-to-severe versus mild cases, for the plantar forefoot versus hindfoot location, for the concomitant peripheral artery disease versus without and in the high versus low neutrophil-to-lymphocyte ratio (all p < 0.01). The results showed that ulcer severity (p < 0.01), ulcer site (p < 0.01), peripheral artery disease (p < 0.01), neutrophil-to-lymphocyte ratio (p < 0.01) and Controlling Nutritional Status score (p < 0.05) were independent risk factors for amputation in diabetic foot ulcer patients and have predictive values for diabetic foot ulcer progression to amputation.
糖尿病足溃疡常导致截肢，而营养状况和免疫功能都与这一过程有关。我们旨在研究与糖尿病溃疡相关的截肢风险因素，包括控制营养状况评分和中性粒细胞与淋巴细胞比值生物标志物。我们评估了来自医院的糖尿病足溃疡患者的数据，进行单变量和多变量分析以筛选高风险因素，并进行 Kaplan-Meier 分析以关联高风险因素与无截肢生存率。总体而言，389 例患者在随访期间进行了 247 次截肢。在对相关变量进行校正后，我们确定了与糖尿病溃疡相关的截肢的五个独立风险因素：溃疡严重程度、溃疡部位、外周动脉疾病、中性粒细胞与淋巴细胞比值和营养状况。中度至重度溃疡与轻度溃疡相比、足底前足与后足部位相比、合并外周动脉疾病与无外周动脉疾病相比、中性粒细胞与淋巴细胞比值高与低相比，无截肢生存率均较低（均 p<0.01）。结果表明，溃疡严重程度（p<0.01）、溃疡部位（p<0.01）、外周动脉疾病（p<0.01）、中性粒细胞与淋巴细胞比值（p<0.01）和控制营养状况评分（p<0.05）是糖尿病足溃疡患者截肢的独立风险因素，对糖尿病足溃疡进展为截肢具有预测价值。
