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Risk factors affecting amputation in diabetic foot.

Jun Ho Lee1, Ji Sung Yoon2, Hyoung Woo Lee2

  • 1Republic of Korea Army, Hwacheon, Korea.

Yeungnam University Journal of Medicine
|May 7, 2020
PubMed
Summary

Diabetic foot ulcers (DFU) often lead to lower extremity amputations (LEA). Key risk factors for LEA in DFU patients include osteomyelitis, peripheral artery disease, chronic kidney disease, ulcer size, and forefoot ulcer location.

Keywords:
AmputationDiabetes mellitusDiabetic foot ulcerRisk factors

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Area of Science:

  • Podiatry
  • Diabetology
  • Vascular Surgery

Background:

  • Diabetic foot ulcers (DFU) are a leading cause of non-traumatic lower extremity amputations (LEA).
  • Identifying risk factors for LEA in DFU patients is crucial for preventative strategies.

Purpose of the Study:

  • To assess the risk factors associated with lower extremity amputations (LEA) in patients diagnosed with diabetic foot ulcers (DFU).

Main Methods:

  • A retrospective study analyzed 351 patients with DFUs from January 2010 to December 2018.
  • Variables included demographics, disease history, laboratory data, ankle-brachial index, Wagner classification, osteomyelitis, sarcopenia index, and ulcer size.
  • Multivariate logistic regression and chi-square tests were employed to identify significant risk factors.

Main Results:

  • Osteomyelitis (HR 6.164), lesions on percutaneous transluminal angioplasty (HR 2.494), reduced estimated glomerular filtration rate (eGFR; HR 0.99), larger ulcer size (HR 1.247), and forefoot ulcer location (HR 2.475) were significantly associated with amputation risk.
  • Out of 351 patients, 170 underwent LEA.
  • No significant age or diabetes duration differences were found between patients who did and did not require amputation.

Conclusions:

  • Osteomyelitis, peripheral artery disease, chronic kidney disease, ulcer size, and forefoot ulcer location are significant risk factors for amputation in diabetic foot patients.
  • These findings can inform the development of a risk stratification system for diabetic foot patients.
  • Establishing such a system will facilitate optimized, individualized treatment plans.