Details
Category: Volume 07 Issue 09 September 2019
Hits: 1128

Title: Evaluation of Risk factors in diabetic foot ulcers patient as predictors of lower extremity amputation: a hospital-based case control study

Author: Abdulbassit M. Alshallwi

 DOI: https://dx.doi.org/10.18535/jmscr/v7i9.21

Abstract

     

Background: Diabetic foot ulcers (DFU) may cause significant morbidity and lower extremity amputation (LEA) compared to the general population. The purpose of the present study was to quantify the risk factors of subsequent amputation in hospitalized Diabetic foot ulcers (DFU) patients.

Methods: We performed a hospital-based, case-control study of 94 DFU patients with LEA and 94 control DFU patients without LEA, the control subjects were matched to cases in respect to age, sex, and nutritional status, with ratio of 1:1. This study was conducted in Derna Teaching Hospital between January 2016 and December 2018, patients’ demographical data and all risk factors-related information were collected from clinical records using pre-designed format, using (LEA) as the outcome variable, we calculated odds ratios (ORs) and 95% confidence intervals (CIs) by logistic regression, which used to assess the independent effect of selected risk factors associated with LEA, the data were analyzed in SPSS version 21.

Results: There were 94 case-control pairs, all of which were diagnosed with type 2 diabetes mellitus, seven potential independent variables show a promise of influence, the latter being defined as p50.15 upon univariate analysis, multivariable logistic regression identified levels of HbA1c 8% (OR 20.47, 95% CI 3.12-134.31; p-0.002), presence of peripheral arterial disease (PAD) (OR 12.97, 95% CI 3.44-48.88; pB0.001), hypertriglyceridemia (OR 5.58, 95% CI 1.74-17.91; p-0.004), and hypertension (OR 3.67, 95% CI 1.14-11.79; p-0.028) as the independent risk factors associated with subsequent lower extremity amputation in Diabetic foot ulcers.

Conclusions: Several risk factors for LEA were identified, we found that HbA1c >8%, PAD, hypertriglyceridemia, and hypertension have been recognized as the predictors of LEA in this study, good glycemic control, active investigation against PAD, and management of comorbidities such as hypertriglycemia and hypertension are considered important to reduce amputation risk.

Keywords: diabetic foot ulcers; hospitalized patients; risk factors; amputation

References

  1. jokomoeljanto    Tinjauan  umum   tentang   kaki   diabetes.In:  Djokomoeljanto  R,  Darmono,  Suhartono  T,  eds.  Kakidiabetik:  Patogenesis  dan  penatalaksanaan.  Semarang:  Dipo-negoro University; 1997, pp. 110.
  2. Reiber    The   epidemiology   of   diabetic   foot   problems. Diabetic Med 1996; 13: 611.
  3. Thewjitcharoen Y, Krittiyawong S,  Porramatikul  S,  Parksook W,   Chatapat   L,   Watchareejirachot   O,   et      Outcomes   ofhospitalized  diabetic  foot  patients  in  a  multi-disciplinary  teamsetting: Thailand’s experience. J Clin Transl Endocrinol 2014; 1:18791.
  4. van Houtum    Diabetes  related  lower  extremity  ampu-tations.   Master   dissertation,   Vrije   University,  Amsterdam The Netherland, 1998.
  5. Abbas ZG. Reducing  diabetic  limb  amputations  in  Expert Rev Endocrinol Metab 2015; 10: 42534.
  6. Unwin N, Mackintosh J, La Porte R, Chang YF, Renzie R, onbehalf of  The  Global  Lower  Extremity  Study    Epide-miology  of  lower  extremity  amputation  in  centres  in  Europe, North America and East Asia. Br J Surg 2000; 87: 32837.
  7. Dillingham TR,  Pezzin  LE,  MacKenzie    Limb  amputationand  limb  deficiency:  epidemiology  and  recent  trends  in  the United States. South Med J 2002; 95: 87583.
  8. Pecoraro RE,  Reiber  GE,  Burgess    Pathways to diabeticlimb amputation: basis for prevention. Diabetes Care 1990; 13:51321.
  9. Bowker JH. Minor  and  major  lower  limb  amputations  anddisarticulations  in  patients  with  diabetes    In:  BowkerJH,  Pfeifer  MA,  eds.  Levin  and  O’Neal’s:  the  diabetic  foot.Philadelphia, PA: Mosby Elsevier; 2008, pp. 40328.
  10. Moss SE, Klein R, Klein BEK. The prevalence and incidence of lower extremity amputation in a  diabetic    Arch Intern Med 1992; 152: 61016.
  11. Lehto S, Ronnemaa T, Pyorala K, Laakso M. Risk factors pre-dicting lower  extremity  amputation  in  patients with  Diabetes Care 1996; 19: 60712.
  12. Shojaiefard A,   Khorgami   Z,   Larijani      Independent   risk factors for  amputation  in  diabetic  foot.  Int J  Diabetes  Dev Ctries 2008; 28: 327.
  13. Lacle A,   Valero-Juan      Diabetes-related lower-extremity amputation incidence and risk factors: a prospective seven-yearstudy in Costa Rica. Rev Panam Salud Publica 2012; 32: 1928.
  14. Martins-Mendes D, Monteiro-Soares M, Boyko EJ, Ribeiro M,Barata P, Lima J, et al. The independent contribution of diabeticfoot ulcer  on  lower  extremity  amputation  and  mortality  J Diabetes Complications 2014; 28: 6328.
  15. Lee JS,  Lu  ML,  Lee  VS,  Russel  D,  Bahr  C,  Lee    Lower-extremity  amputation:  incidence,  risk  factors  and  mortalityin  the  Oklahoma  Indian  Diabetes  Study.  Diabetes 1993;  42:87682.
  16. Resnick HE,  Carter  EA,  Sosenko  JM,  Henly  SJ,  Fabsitz  RR,Ness  FK,  et    Incidence  of  lower-extremity  amputation  inAmerican Indians: the Strong Heart Study. Diabetes Care 2004;27: 188591.
  17. Miyajima S,  Shirai  A,  Yamamoto  S,  Okada  N,  Matsushita  Risk   factors   for   major   limb   amputations   in   diabetic   footgangrene patients. Diabetes Res Clin Pract 2006; 71: 2729.
  18. Aziz Z,  Lin  WK,  Nather  A,  Huak    Predictive factors  forlower extremity amputations in diabetic foot infections. DiabeticFoot Ankle 2011; 2. doi: http://dx.doi.org/10.3402/dfa.v2i0.7463
  19. Zubair M, Malik A,  Ahmad    Incidence, risk  factors  foramputation among patients with diabetic foot ulcer in a NorthIndian tertiary care hospital. Foot 2012; 22: 2430.
  20. Wagner FW Jr. The diabetic foot. Orthopedics 1987; 10: 16372..
  21. Hosmer DW, Lemeshow S. Applied logistic regression, 2nd ed.Hoboken, NJ: Wiley; 2000.
  22. Marcovecchio ML, Lucantoni M, Chiarelli    Role  of chronicand   acute   hyperglycemia   in   the   development   of   diabetes complications. Diabetes Technol Ther 2011; 13: 38994.
  23. Adler AI,  Erqou  S,  Lima  TA,  Robinson    Association between  glycated  hemoglobin  and  the  risk  of  lower  extremity amputation  in  patients  with  diabetes  mellitus review  andmeta-analysis. Diabetologia 2010; 53: 8409.
  24. Stratton IM,  Adler  AI,  Neil  HA,  Matthews  DR,  Manley  SE, Cull CA, et al. Association of glycemia with macro vascular and microvascular  complications  of  type  2  diabetes  (UKPDS  35): prospective observational study. BMJ 2000; 321: 40512.
  25. Gaede P, Lund-Andersen H, Parving HH, Pedersen O. Effect ofa multifactorial intervention on mortality in type 2 diabetes. NEngl J Med 2008; 358: 58091.
  26. Lipsky BA, Weigelt JA, Sun X, Johannes RS, Derby KG, TabakYP. Developing and validating a risk score for lower-extremity amputation in patients hospitalized for a diabetic foot infection. Diabetes Care 2011; 34: 169570

Corresponding Author

Dr Abdulbassit M.Alshallwi

Associated Professor, Department of Surgery

Faculty of Medicine- Omar Almukhtar University