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Pedal medial arterial calcification in diabetic foot ulcers: A significant risk factor of amputation and mortality
Lihong Chen1,2, Dawei Chen1, Hongping Gong3
1Department of Endocrinology & Metabolism, West China Hospital, Sichuan University, Chengdu, China.
Insights
Pedal medial arterial calcification (MAC) in diabetic foot ulcers (DFUs) significantly increases amputation and mortality risks. This finding suggests pedal MAC is a valuable predictor for DFU complications beyond peripheral artery disease (PAD).
Area of Science:
- Vascular Medicine
- Diabetology
- Podiatry
Background:
- Diabetic foot ulcers (DFUs) are a major cause of morbidity and mortality.
- Pedal medial arterial calcification (MAC) is common in DFU patients, but its prognostic significance is unclear.
- Peripheral artery disease (PAD) is a known risk factor for DFU complications.
Purpose of the Study:
- To investigate the association between pedal MAC and outcomes in patients with DFUs.
- To determine if pedal MAC predicts amputation and mortality in DFU patients.
- To assess the added value of pedal MAC in predicting amputation compared to PAD.
Main Methods:
- Prospective observational cohort study (2012-2021) at West China Hospital.
- 979 patients with DFUs were analyzed.
- Logistic regression, Kaplan-Meier survival, and Cox proportional hazards models were used to assess outcomes.
Main Results:
- Pedal MAC was present in 8% of DFU patients.
- Pedal MAC was significantly associated with increased risk of amputation (OR 2.29) and mortality (p=0.005).
- The risk of amputation was twofold higher in patients with both PAD and pedal MAC compared to PAD alone.
Conclusions:
- Pedal MAC is a significant independent predictor of amputation and mortality in individuals with DFUs.
- Pedal MAC offers additional predictive value for amputation risk in DFU patients, beyond PAD assessment.
- Routine assessment of pedal MAC may improve risk stratification and management of DFU patients.
Aims:
Pedal medial arterial calcification (MAC) is frequently observed in individuals with diabetic foot ulcers (DFUs). However, the impact of pedal MAC on individuals with DFUs remains uncertain. The main aim of this study was to evaluate the association between pedal MAC with amputation and mortality outcomes.
Methods:
A prospective, observational cohort study was conducted at West China Hospital from January 2012 to December 2021. Logistic regression analyses, Kaplan-Meier survival method, and Cox proportional hazards models were employed to evaluate the relationship between pedal MAC and amputation as well as mortality.
Results:
A total of 979 patients were enrolled in the study. Peripheral artery disease (PAD) was observed in 53% of patients with DFUs, and pedal MAC was found in 8%. Over a median follow-up of 46 (23-72) months, foot amputation was performed on 190 patients, and mortality occurred in 246 patients. Pedal MAC showed a significant association with amputation both in unadjusted analysis (odds ratio [OR] = 2.98, 95% confidence interval [CI] = 1.86-4.76, p < .001) and after adjusting sex, age, albumin levels, hemoglobin levels, and diabetic retinopathy status (OR 2.29, 95% CI 1.33-3.93, p = .003). The risk of amputation was found to be twofold higher in individuals with PAD and pedal MAC compared to those with PAD alone (OR 2.05, 95% CI 1.10-3.82, p = .024). Furthermore, the presence of pedal MAC was significantly associated with an increased risk of mortality (p = .005), particularly among individuals with DFUs but without PAD (HR 4.26, 95% CI 1.90-9.52, p < .001), rather than in individuals presenting with both DFUs and PAD.
Conclusion:
The presence of pedal MAC is significantly associated with both amputation and mortality in individuals with DFUs. Moreover, pedal MAC could provide additional value to predict amputation other than PAD.
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