Meloni Marco, Andreadi Aikaterini, Bellizzi Ermanno, Giurato Laura, Ruotolo Valeria, Romano Maria, Bellia Alfonso, Uccioli Luigi, Lauro Davide
Department of Systems Medicine, University of Rome "Tor Vergata", Rome, Italy.
Division of Endocrinology and Diabetology, Department of Medical Sciences, Fondazione Policlinico "Tor Vergata", Rome, Italy.
Diabetes Metab Res Rev. 2023 Oct;39(7):e3690. doi: 10.1002/dmrr.3690. Epub 2023 Jul 9.
The current study aims to evaluate the effectiveness of a multidisciplinary diabetic foot team (MDFT) in the management of in-patients affected by diabetic foot problems.
The study was a retrospective observational study. Consecutive patients with a diabetic foot problem requiring hospitalisation were included. All patients were managed by a MDFT led by diabetologists according to the guidance. The rate of in-hospital complications (IHCs), major amputation, and survival were recorded at the end of patient's hospitalisation. IHC was defined as any new infection different from wound infection, cardiovascular events, acute renal injury, severe anaemia requiring blood transfusion, and any other clinical problem not present at the assessment.
Overall, 350 patients were included. The mean age was 67.9 ± 12.6 years, 254 (72.6%) were males, 323 (92, 3%) showed Type 2 diabetes with a mean duration of 20.2 ± 9.6 years; 224 (64%) had ischaemic diabetic foot ulcers (DFUs) and 299 (85.4%) had infected DFUs. IHCs were recorded in 30/350 (8.6%) patients. The main reasons for IHCs were anaemia requiring blood transfusion (2.8%), pneumonia (1.7%), acute kidney failure (1.1%). Patients with IHCs showed a higher rate of major amputation (13.3 vs. 3.1%, p = 0.02) and mortality (16.7 vs. 0.6%, p < 0.0001) in comparison to those without. Ischaemic heart disease (IHD) and wound duration at the assessment (>1 month) were independent predictors of IHC, whereas IHCs, heart failure, and dialysis were independent predictors of in-hospital mortality.
The multidisciplinary management of diabetic foot problems leads to an IHC rate of 8%. The risk of IHCs is higher in patients with IHD and long wound duration.
本研究旨在评估多学科糖尿病足团队（MDFT）对糖尿病足问题住院患者的管理效果。
本研究为回顾性观察研究。纳入连续的因糖尿病足问题需住院治疗的患者。所有患者均由内分泌科医生主导的多学科糖尿病足团队按照指南进行管理。在患者住院结束时记录院内并发症（IHC）发生率、大截肢率和生存率。IHC定义为不同于伤口感染的任何新发感染、心血管事件、急性肾损伤、需要输血的严重贫血以及评估时不存在的任何其他临床问题。
共纳入350例患者。平均年龄为67.9±12.6岁，男性254例（72.6%），323例（92.3%）为2型糖尿病，平均病程20.2±9.6年；224例（64%）有缺血性糖尿病足溃疡（DFU），299例（85.4%）有感染性DFU。30/350例（8.6%）患者记录有IHC。IHC的主要原因是需要输血的贫血（2.8%）、肺炎（1.7%）、急性肾衰竭（1.1%）。与无IHC的患者相比，有IHC的患者大截肢率更高（13.3%对3.1%，p=0.02），死亡率更高（16.7%对0.6%，p<0.0001）。缺血性心脏病（IHD）和评估时伤口持续时间（>1个月）是IHC的独立预测因素，而IHC、心力衰竭和透析是院内死亡的独立预测因素。
糖尿病足问题的多学科管理导致IHC发生率为8%。IHD患者和伤口持续时间长的患者发生IHC的风险更高。
