Bodinger Sofia, Wikström Tove, Gottsäter Anders, Acosta Stefan
Department of Clinical Sciences, Lund University, Malmö, Sweden.
Department of Medicine, Skåne University Hospital, Malmö, Sweden.
Ther Adv Endocrinol Metab. 2025 Aug 22;16:20420188251362729. doi: 10.1177/20420188251362729. eCollection 2025.
Chronic limb-threatening ischaemia (CLTI) causes high rates of amputation and mortality.
To compare incidence, management and prognosis in hospitalised patients with CLTI with and without diabetes mellitus (DM) in 2001 and 2023. A secondary objective was to compare adherence to global vascular guidelines on risk factors between patients with and without DM in 2023.
Retrospective study.
Group differences were tested using the Mann-Whitney test, independent sample test or the Chi-square test, as appropriate. The effects of DM on major amputation or mortality at 1 year were evaluated in a multivariable logistic regression model according to a directed acyclic graph.
The incidence of hospitalisations for CLTI was reduced from 37.4 (95% confidence interval (CI), 33.3-41.6) in 2001 to 22.8 (95% CI, 19.7-25.8) per 100,000 person-years in 2023. The proportion of patients on full-dose oral anticoagulant therapy ( < 0.001) and lipid-lowering treatment ( < 0.001) increased significantly between the two time periods. In 2023, Wounds, Ischemia and foot Infection-classification in all patients with foot ulcers was documented in 6.9%. Anaemia was present at hospital admission in 67.0% and 52.5% of patients with CLTI with and without DM, respectively ( = 0.031). Endovascular therapy was performed more often in those with DM compared to those without DM ( = 0.004). Antiplatelet therapy ( = 0.008) and smoking cessation interventions ( = 0.033) were offered less often to those with DM. DM (odds ratio (OR), 1.7 (95% CI, 1.02-2.83)) was independently associated with increased mortality at 1 year, whereas period 2023 as opposed to 2001 (OR, 0.62 (95% CI, 0.38-0.99)) was associated with decreased mortality.
The incidence of hospitalisation for CLTI appears to have been reduced, and medical care of patients with CLTI has improved prognosis. Nevertheless, there is still room for large improvements of secondary prevention care in patients with CLTI, particularly in those with DM.
慢性肢体威胁性缺血（CLTI）导致高截肢率和死亡率。
比较2001年和2023年住院的合并和未合并糖尿病（DM）的CLTI患者的发病率、治疗和预后。次要目的是比较2023年合并和未合并DM的患者对全球血管危险因素指南的依从性。
回顾性研究。
根据情况，使用曼-惠特尼检验、独立样本检验或卡方检验来检验组间差异。根据有向无环图，在多变量逻辑回归模型中评估DM对1年时大截肢或死亡的影响。
CLTI住院率从2001年的每10万人年37.4（95%置信区间（CI），33.3 - 41.6）降至2023年的每10万人年22.8（95%CI，19.7 - 25.8）。两个时间段之间，接受全剂量口服抗凝治疗（<0.001）和降脂治疗（<0.001）的患者比例显著增加。2023年，所有足部溃疡患者中记录了6.9%的伤口、缺血和足部感染分类。CLTI合并和未合并DM的患者入院时贫血发生率分别为67.0%和52.5%（=0.031）。与未患DM的患者相比，DM患者接受血管内治疗的频率更高（=0.004）。DM患者接受抗血小板治疗（=0.008）和戒烟干预（=0.033）的频率较低。DM（比值比（OR），1.7（95%CI，1.02 - 2.83））与1年时死亡率增加独立相关，而与2001年相比，2023年（OR，0.62（95%CI，0.38 - 0.99））与死亡率降低相关。
CLTI住院率似乎有所降低，CLTI患者的医疗护理改善了预后。然而，CLTI患者二级预防护理仍有很大改进空间，尤其是合并DM的患者。
