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Identifying major predictors of lower-extremity amputation in patients with diabetic foot ulcers

Cherng-Kang Perng1,2, Hsuan-Yu Chou1, Yu-Jen Chiu1,2,3

  • 1Division of Plastic and Reconstructive Surgery, Department of Surgery, Taipei Veterans General Hospital, Taipei, Taiwan, ROC.

Journal of the Chinese Medical Association : JCMA
|December 16, 2020
PubMed

Insights

Diabetic foot ulcers (DFU) pose a significant risk for lower limb amputation. Peripheral arterial disease (PAD), elevated C-reactive protein (CRP) levels, and extended hospital stays are key risk factors. Endovascular intervention shows promise in preventing major amputations in PAD patients.

Area of Science:

  • Podiatry
  • Vascular Surgery
  • Diabetology

Background:

  • Diabetic foot ulcer (DFU) represents a significant global health challenge.
  • Effective identification of risk factors for amputation is crucial for limb salvage.
  • Previous research indicates various factors contributing to DFU-related amputations.

Purpose of the Study:

  • To investigate independent risk factors associated with lower limb amputation in patients diagnosed with diabetic foot ulcers.
  • To identify potential protective factors against amputation in this patient cohort.

Main Methods:

  • Retrospective chart review of 646 patients with DFU admitted between 2012 and 2017.
  • Statistical analyses including Chi-square test, dependent t test, and multivariate logistic regression.
  • Evaluation of limb salvage, minor, and major amputation as endpoints.

Main Results:

  • Peripheral arterial disease (PAD) (OR, 3.196), elevated C-reactive protein (CRP) levels (OR, 1.046), and longer hospital stay (OR, 1.019) were identified as independent risk factors for amputation.
  • A significant proportion of patients (24.6%) underwent lower limb amputation.
  • Endovascular intervention was found to be a protective factor against major amputation in patients with PAD (OR, 0.271).

Conclusions:

  • Peripheral arterial disease (PAD), C-reactive protein (CRP) levels, and hospital stay duration are critical independent risk factors for amputation in diabetic foot ulcer patients.
  • Endovascular intervention demonstrates a protective effect against major amputation, particularly in patients with PAD.
  • Addressing these risk factors is essential for improving outcomes and limb salvage rates in DFU management.
Abstract

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