McCown Sheldon A, Walters Elliot T, Palackic Alen, Franco-Mesa Camila, Davis Ashton R, Keys Phillip H, Song Juquan, Wolf Steven E
School of Medicine, University of Texas Medical Branch, Galveston, TX 77555, USA.
Department of Surgery, University of Texas Medical Branch, Galveston, TX 77555, USA.
Eur Burn J. 2024 Nov 8;5(4):399-409. doi: 10.3390/ebj5040035.
Diabetic patients often present with complex limb pathology, resulting in impaired sensation in the distal extremities making tactile injuries such as burns difficult to notice. We posit that poorly controlled diabetes mellitus, evidenced by increasing elevations in hemoglobin A1c, is associated with delayed wound healing and increased complications in burn patients.
The TriNetX Network, a database of 89 million patients across the U.S., was queried for diabetic patients with foot and ankle burns. Patients were divided into four groups based on A1c: properly controlled (<7%), moderately controlled (7-9%), poorly controlled (>9%), and propensity-matched non-diabetic controls. Evaluated outcomes included split-thickness skin grafting, infections, amputations, acute kidney failure (AKF), and mortality within one month of the burn.
When comparing the poorly controlled A1c cohort with the properly controlled and moderately controlled A1c cohorts, we found a significant increase in amputations ( = 0.042) and cutaneous infections ( = 0.0438), respectively. When evaluating non-diabetics to diabetic patients, significantly increased rates of amputations ( < 0.0001), cutaneous infections ( = 0.0485), systemic infections ( = 0.0066), and AKF ( = 0.0005) were noted in the latter.
Poorly controlled diabetes shows a significant correlation with increased complications following foot and ankle burns, including amputations, infections, and AKF.
糖尿病患者常伴有复杂的肢体病变，导致远端肢体感觉受损，使得烧伤等触觉损伤难以察觉。我们认为，糖化血红蛋白水平不断升高所证明的糖尿病控制不佳与烧伤患者伤口愈合延迟及并发症增加有关。
查询了TriNetX网络（一个涵盖美国8900万患者的数据库）中患有足踝部烧伤的糖尿病患者。根据糖化血红蛋白将患者分为四组：控制良好（<7%）、中度控制（7-9%）、控制不佳（>9%）以及倾向匹配的非糖尿病对照组。评估的结果包括分层皮片移植、感染、截肢、急性肾衰竭（AKF）以及烧伤后一个月内的死亡率。
将控制不佳的糖化血红蛋白队列与控制良好和中度控制的糖化血红蛋白队列进行比较时，我们分别发现截肢（P = 0.042）和皮肤感染（P = 0.0438）显著增加。在评估非糖尿病患者与糖尿病患者时，发现后者的截肢率（P < 0.0001）、皮肤感染率（P = 0.0485）、全身感染率（P = 0.0066）和急性肾衰竭发生率（P = 0.0005）显著升高。
糖尿病控制不佳与足踝部烧伤后并发症增加显著相关，包括截肢、感染和急性肾衰竭。
