Prognostic Markers of Diabetic Foot Ulcer Healing in A Resource-Limited Setting

This study aimed to identify the prognostic markers for Diabetic Foot Ulcer (DFU) healing using routinely collected clinical data. A prospective cohort study of 1075 (M/F: 664/411) patients who attended the foot clinic with a DFU was conducted. At baseline, detailed clinical data were collected and ulcer characteristics were systematically assessed and classified. During 167 ± 408 days follow-up, ulcers of 1039 patients healed and 36 did not. Ulcers with SINBAD classifications 4, 5 and 6 (compared to SINBAD-3) showed 50%, 60% and 70% increase in the risk of not healing and 2.2, 2.8 and 3.3 folds increase in healing duration respectively. Also, deeper ulcer and having previous ulcer history showed 68% and 47% increase in the risk of ulcer not healing and 57% and 20% increase in healing duration respectively. Each day delay in presentation increased the risk of ulcer not healing by 0.5%. The duration of healing was 2.4 times longer for bigger ulcers (> 1 cm²) and 24% longer in patients with peripheral arterial disease. SINBAD score was the strongest predictor of ulcer healing. Among SINBAD constitutive components, ulcer depth (deep-vs-shallow) was the strongest predictor of risk of ulcer not healing, while ulcer size (bigger-vs-smaller than 1 cm²) was the strongest predictor of ulcer healing duration.