School of Public Health, Imperial College, London, UK.
School of Population Health, Royal College of Surgeons in Ireland, Dublin, Ireland.
Diabetologia. 2024 Dec;67(12):2691-2701. doi: 10.1007/s00125-024-06262-w. Epub 2024 Sep 27.
AIMS/HYPOTHESIS: People with diabetes-related foot ulcers (DFUs) have high mortality rates. This analysis assesses the impact of selected risk factors on short-term mortality using a population registered in the National Diabetes Foot Care Audit (NDFA).
Mortality rates at 12, 26 and 52 weeks was assessed in people with a new DFU registered by a specialist diabetes footcare service in the NDFA in England and Wales between April 2017 and March 2022. Poisson regression models were created to explore risk factors for mortality.
In 71,000 people registered with a new DFU, mortality rates at 12, 26 and 52 weeks was 4.2%, 8.2% and 14.4%, respectively. At 26 weeks, higher mortality rates was associated with older age (rate ratio 2.15; 95% CI 2.03, 2.28, for age ≥80 years vs age 65-79 years), certain ulcer characteristics (area ≥1 cm [1.50; 95% CI 1.42, 1.59], deep ulcers [1.26; 95% CI 1.18, 1.35] or hindfoot location [1.53; 95% CI 1.44, 1.62]) and recorded evidence of ischaemia in the lower limb (1.78; 95% CI 1.69, 1.88) and various comorbidities (heart failure [2.13; 95% CI 2.00, 2.26], myocardial infarction [1.45; 95% CI 1.29, 1.63], stroke [1.37; 95% CI 1.22, 1.53], renal replacement therapy [2.34; 95% CI 2.09, 2.61] and chronic kidney disease stage 3 or greater [1.20; 95% CI 1.12, 1.29]). The 26-week mortality rate exceeded 25% for 7.3% of all individuals, rising to 11.5% of those aged 65 years and older, and 22.1% of those aged 80 years and over.
CONCLUSIONS/INTERPRETATION: Short-term mortality rates in people with a DFU is high. Teams managing people with DFUs should consider modifying the burdensome interventions and care required to heal such ulcers so maximising the quality of residual life, rather than focusing exclusively on healing.
目的/假设：患有糖尿病相关足部溃疡（DFU）的人死亡率很高。本分析使用全国糖尿病足部护理审计（NDFA）中登记的人群，评估选定的风险因素对短期死亡率的影响。
在 2017 年 4 月至 2022 年 3 月期间，英格兰和威尔士的专业糖尿病足护理服务在 NDFA 中登记了新的 DFU 患者，评估了这些患者在 12、26 和 52 周时的死亡率。使用泊松回归模型探索死亡风险因素。
在登记患有新 DFU 的 71000 人中，12、26 和 52 周的死亡率分别为 4.2%、8.2%和 14.4%。在 26 周时，较高的死亡率与年龄较大（年龄比 2.15；95%CI 2.03，2.28，年龄≥80 岁 vs 年龄 65-79 岁）、特定的溃疡特征（面积≥1cm[1.50；95%CI 1.42，1.59]、深部溃疡[1.26；95%CI 1.18，1.35]或后足位置[1.53；95%CI 1.44，1.62]）以及记录的下肢缺血证据（1.78；95%CI 1.69，1.88）和各种合并症（心力衰竭[2.13；95%CI 2.00，2.26]、心肌梗死[1.45；95%CI 1.29，1.63]、中风[1.37；95%CI 1.22，1.53]、肾脏替代治疗[2.34；95%CI 2.09，2.61]和慢性肾脏病 3 期或更高级别[1.20；95%CI 1.12，1.29]）有关。所有个体中，7.3%的个体 26 周死亡率超过 25%，65 岁及以上个体的死亡率上升至 11.5%，80 岁及以上个体的死亡率上升至 22.1%。
结论/解释：患有 DFU 的人短期死亡率很高。管理 DFU 患者的团队应考虑修改治疗此类溃疡所需的繁重干预措施和护理，以最大限度地提高剩余生命的质量，而不仅仅是关注溃疡的愈合。
