Clinical outcome and determinants of amputation in a large cohort of Iranian patients with diabetic foot ulcers |
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| Institution: | 1. Department of Endocrinology, The Second Affiliated Hospital of Hainan Medical University, HaiKou 570311, Hainan Province, China;2. Department of Gerontology, The Hainan General Hospital, HaiKou 570311, Hainan Province, China;1. Department of Endocrinology and Diabetes, St Vincent''s Hospital Melbourne, Fitzroy, Victoria, Australia;2. Department of Medicine, University of Melbourne, Fitzroy, Victoria, Australia;3. St Vincent''s Institute of Medical Research, Fitzroy, Victoria, Australia;4. Department of Public Health, La Trobe University, Australia;5. Australian Centre for Accelerating Diabetes Innovations, University of Melbourne, Australia;1. Diabetic Foot Clinic, Endocrinology, Diabetes and Metabolism Department - Centro Hospitalar de Vila Nova de Gaia/Espinho EPE, Vila Nova de Gaia, Portugal;2. Internal Medicine Department - Centro Hospitalar de Vila Nova de Gaia/Espinho EPE, Vila Nova de Gaia, Portugal;3. Biochemistry Department (U38-FCT)-Faculty of Medicine of the University of Porto, Oporto, Portugal;4. CIDES/CINTESIS (U753-FCT)-Health Information and Decision Sciences Department, Oporto Faculty of Medicine, Oporto, Portugal;5. Seattle Epidemiologic Research and Information Centre-Department of Veterans Affairs Puget Sound Health Care System and the University of Washington, Seattle, WA, USA;6. Health Sciences Faculty of the Fernando Pessoa’s University, Oporto, Portugal;7. Cancer Biology Group-Institute of Molecular Pathology and Immunology of the University of Porto, Oporto, Portugal, Faculty of Medicine of the University of Porto, Oporto, Portugal |
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| Abstract: | ObjectiveDetermining the predictive factors of diabetes foot ulcer (DFU) development and lower extremity amputations (LEA) in patients with diabetes mellitus (DM) is of great importance to compose risk stratification models. The aim of this study is to investigate the outcome and predictors of LEA in patients with DFU in large sample of Iranian patients.MethodsThis prospective cohort study was conducted during a 2-year period from 2014 to 2016, in Shiraz, southern Iran. All the patients with type 1 and 2 DM and DFU were included in the cohort and were followed for 2 years at least. They were visited in the clinic on a monthly basis and development of new DFU and LEA were recorded. The two-year free-DFU survival and predictors of the DFU development and LEA were recorded. Multivariate regression models were used to determine the factors.ResultsA total number of 432 patients with mean age of 56.8 ± 13.3 years were included. The two-year DFU-free survival rate was 0.826. The two-year DFU-free survival was associated with male gender (p = 0.005), foot deformity (p = 0.002), history of prior DFU (p < 0.001), cigarette smoking (p = 0.032), nephropathy (p = 0.005), retinopathy (p = 0.007), ischemic heart disease (p = 0.043), and neuropathy (p < 0.001).ConclusionDevelopment of new DFU is associated with higher age, longer duration of disease, and type I diabetes. LEA was associated with increased white blood cell (WBC), Creatinine and ulcer history for major amputation and ulcer history, fasting blood sugar (FBS), infection, revascularization history, and foot deformity, for minor amputation. |
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| Keywords: | Diabetes mellitus (DM) Diabetic foot ulcer (DFU) Amputation Predictors Outcome |
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