Lan Nick S R, Hiew Jonathan, Ferreira Ivana, Ritter J Carsten, Manning Laurens, Fegan P Gerry, Hamilton Emma J, Dwivedi Girish
Centre of Excellence for Cardiometabolic Health, Fiona Stanley Hospital, Perth, Australia.
Department of Cardiology, Fiona Stanley Hospital, Perth, Australia.
Physiol Rep. 2025 Jun;13(11):e70415. doi: 10.14814/phy2.70415.
In patients with diabetes-related foot ulceration (DFU), ulcer severity and chronic kidney disease (CKD) portend worse outcomes. We evaluated the combined impact of a severe ulcer with CKD on major adverse cardiovascular events (MACE) in patients with DFU. Ulcer severity was defined using the SINBAD (site, ischaemia, neuropathy, bacterial infection, area, depth) classification, dividing into low (1-3) or high (4-6). CKD was defined as an estimated glomerular filtration rate <60 mL/min/1.73 m. Patients were categorized into four groups based on SINBAD and CKD category. MACE was defined as hospitalization for myocardial infarction, stroke or transient ischemic attack, or heart failure. Of 497 patients, 236 (47.5%) were SINBAD-low/CKD-absent, 80 (16.1%) SINBAD-high/CKD-absent, 127 (25.6%) SINBAD-low/CKD-present, and 54 (10.9%) SINBAD-high/CKD-present. The median follow-up was 410 (interquartile range 242-576) days for MACE and 387 (221-549) days for MACE or all-cause mortality. SINBAD-high/CKD-present was associated with significantly higher MACE (SINBAD-low/CKD-absent 4.2%; SINBAD-high/CKD-absent 7.5%; SINBAD-low/CKD-present 9.5%; SINBAD-high/CKD-present 33.3%; log-rank p < 0.001) and MACE or all-cause mortality (SINBAD-low/CKD-absent 5.5%; SINBAD-high/CKD-absent 13.8%; SINBAD-low/CKD-present 17.4%; SINBAD-high/CKD-present 53.7%; log-rank p < 0.001). SINBAD-high/CKD-present was associated with MACE (p < 0.001) and MACE or all-cause mortality (p < 0.001) after multivariate adjustment. Severe DFU with CKD amplifies the risk of MACE in patients with DFU, suggesting important implications for cardiovascular risk assessment.
在糖尿病相关足部溃疡（DFU）患者中，溃疡严重程度和慢性肾脏病（CKD）预示着更差的预后。我们评估了严重溃疡合并CKD对DFU患者主要不良心血管事件（MACE）的综合影响。溃疡严重程度采用SINBAD（部位、缺血、神经病变、细菌感染、面积、深度）分类法进行定义，分为低（1 - 3）级或高（4 - 6）级。CKD定义为估计肾小球滤过率<60 mL/min/1.73 m²。根据SINBAD和CKD类别将患者分为四组。MACE定义为因心肌梗死、中风或短暂性脑缺血发作或心力衰竭住院。在497例患者中，236例（47.5%）为SINBAD低/无CKD，80例（16.1%）为SINBAD高/无CKD，127例（25.6%）为SINBAD低/有CKD，54例（10.9%）为SINBAD高/有CKD。MACE的中位随访时间为410天（四分位间距242 - 576天），MACE或全因死亡率的中位随访时间为387天（四分位间距221 - 549天）。SINBAD高/有CKD与显著更高的MACE发生率相关（SINBAD低/无CKD为4.2%；SINBAD高/无CKD为7.5%；SINBAD低/有CKD为9.5%；SINBAD高/有CKD为33.3%；对数秩检验p<0.001）以及MACE或全因死亡率相关（SINBAD低/无CKD为5.5%；SINBAD高/无CKD为13.8%；SINBAD低/有CKD为17.4%；SINBAD高/有CKD为53.7%；对数秩检验p<0.001）。多变量调整后，SINBAD高/有CKD与MACE（p<0.001）和MACE或全因死亡率（p<0.001）相关。严重DFU合并CKD会增加DFU患者发生MACE的风险，提示对心血管风险评估具有重要意义。
