*Geisinger Community Medical Center, Scranton, PA. Dr. Kempf is now with Des Moines University, College of Podiatric Medicine and Surgery, Des Moines, IA.
†Temple University School of Podiatric Medicine, Philadelphia, PA.
J Am Podiatr Med Assoc. 2024 Jan-Feb;114(1). doi: 10.7547/21-187.
Lower-extremity amputations are a common complication of poorly controlled diabetes and contribute to significant morbidity and mortality in diabetic patients. We sought to determine whether objective data points obtained on presentation or hospital admission, including white blood cell (WBC) count, hemoglobin A1c (HbA1c), C-reactive protein (CRP), and descriptive patient demographics allow for the ability to predict optimal amputation levels and outcomes of lower-extremity amputation in the diabetic population.
A retrospective analysis of 162 patients was performed evaluating laboratory and descriptive values on hospital presentation for lower-extremity infection during a 16-year period. Occurrence of multiple amputations and level of amputation were assessed against laboratory values to determine whether these objective values would provide clinicians with a better understanding of amputations in the diabetic patient.
The mean patient age was 60.6 years. A significantly higher percentage of patients who underwent amputations through the tibia and fibula or of the foot midtarsal were male compared with patients who underwent amputations of the thigh through femur. Patients who had amputations through the tibia and fibula had a significantly higher WBC count compared with patients who had a transmetatarsal amputation (P = .03). There was no significant difference in type or quantity of amputations when analyzing HbA1c and CRP levels.
An admission WBC count may be used as a predictor of lower-extremity amputation level and outcomes in diabetic infections. Although a statistically significant difference was not found for CRP or HbA1c levels between amputation procedures and number of procedures performed, these values remain useful in managing lower-extremity infections in diabetic patients.
下肢截肢是糖尿病控制不佳的常见并发症，会导致糖尿病患者的发病率和死亡率显著增加。我们试图确定在就诊或住院时获得的客观数据点，包括白细胞计数（WBC）、糖化血红蛋白（HbA1c）、C 反应蛋白（CRP）和描述性患者人口统计学特征，是否能够预测糖尿病患者下肢截肢的最佳截肢水平和结果。
对 162 例患者进行回顾性分析，评估了 16 年期间下肢感染住院时的实验室和描述性值。评估实验室值与截肢发生的关系，以确定这些客观值是否能让临床医生更好地了解糖尿病患者的截肢情况。
患者的平均年龄为 60.6 岁。与接受股骨大腿截肢的患者相比，接受胫骨和腓骨或足部中跗骨截肢的患者中，男性的比例明显更高。接受胫骨和腓骨截肢的患者的白细胞计数明显高于接受经跖骨截肢的患者（P =.03）。分析 HbA1c 和 CRP 水平时，手术类型或数量没有显著差异。
入院时的白细胞计数可作为预测糖尿病感染下肢截肢水平和结果的指标。尽管 CRP 或 HbA1c 水平在截肢手术和手术次数之间没有统计学上的显著差异，但这些值在管理糖尿病患者的下肢感染方面仍然有用。
