Tarricone Arthur, Coye Tyler L, Gee Allen, Najafi Bijan, Siah Michael C, Lavery Lawrence A
Department of Orthopedic Surgery, The University of Texas Health Science Center, San Antonio, Texas, USA.
Michael E DeBakey Department of Surgery, Baylor College of Medicine, Houston, Texas, USA.
Int Wound J. 2025 May;22(5):e70122. doi: 10.1111/iwj.70122.
To evaluate the association between presenting estimated glomerular filtration rate (eGFR) and clinical outcomes in patients hospitalized with diabetic foot infections. This retrospective cohort study included 344 patients with moderate to severe diabetic foot infections. Patients were categorized into three groups based on presenting estimated eGFR: eGFR ≥60 (eGFR >60 mL/min), eGFR 30-60 (eGFR 30-60 mL/min) and eGFR <30 (eGFR <30 mL/min). Outcomes assessed included wound healing, time to heal, re-infection, amputation, mortality and re-hospitalization for infection. Compared with patients with eGFR <30, patients with eGFR ≥60 had significantly lower rates of retinopathy, peripheral arterial disease and use of beta blockers or calcium channel blockers. Glycated haemoglobin levels were inversely related to eGFR, decreasing as eGFR severity increased. Haemoglobin levels were significantly lower, and inflammatory markers (ESR and CRP) were significantly higher in patients with eGFR <30. There were no significant differences among eGFR groups in rates of wound healing, time to heal, re-infection or amputation. However, mortality increased with decreasing eGFR (1.9% in eGFR ≥60 vs. 3.2% in eGFR 30-60 vs. 8.1% in eGFR <30; p = 0.04). Similarly, re-hospitalization for infection at a different site also increased with decreasing eGFR (20.5% in eGFR ≥60 vs. 28.1% in eGFR 30-60 vs. 48.4% in eGFR <30; p < 0.01). In diabetic foot infections, presenting eGFR severity did not affect rates of wound healing, time to heal, re-infection or amputation. However, decreasing eGFR was associated with increased mortality and re-hospitalization for infection at a different site. In this study, presenting eGFR was not a predictive value for wound healing or time until healing, however was associated with rehospitalization and overall mortality this diabetic foot population.
评估糖尿病足感染住院患者的初始估计肾小球滤过率（eGFR）与临床结局之间的关联。这项回顾性队列研究纳入了344例中重度糖尿病足感染患者。根据初始估计eGFR将患者分为三组：eGFR≥60（eGFR>60 mL/分钟）、eGFR 30 - 60（eGFR 30 - 60 mL/分钟）和eGFR<30（eGFR<30 mL/分钟）。评估的结局包括伤口愈合、愈合时间、再次感染、截肢、死亡率以及因感染再次住院的情况。与eGFR<30的患者相比，eGFR≥60的患者视网膜病变、外周动脉疾病以及使用β受体阻滞剂或钙通道阻滞剂的发生率显著更低。糖化血红蛋白水平与eGFR呈负相关，随着eGFR严重程度增加而降低。eGFR<30的患者血红蛋白水平显著更低，炎症标志物（红细胞沉降率和C反应蛋白）显著更高。eGFR组之间在伤口愈合率、愈合时间、再次感染或截肢率方面无显著差异。然而，死亡率随着eGFR降低而增加（eGFR≥60组为1.9%，eGFR 30 - 60组为3.2%，eGFR<30组为8.1%；p = 0.04）。同样，因不同部位感染再次住院的情况也随着eGFR降低而增加（eGFR≥60组为20.5%，eGFR 30 - 60组为28.1%，eGFR<30组为48.4%；p<0.01）。在糖尿病足感染中，初始eGFR严重程度不影响伤口愈合率、愈合时间、再次感染或截肢率。然而，eGFR降低与死亡率增加以及因不同部位感染再次住院有关。在本研究中，初始eGFR对伤口愈合或愈合时间没有预测价值，但与该糖尿病足人群的再次住院和总体死亡率有关。
