Evaluation of outcomes in patients with diabetic foot ulcers based on initial assessment at admission

To determine the outcomes of diabetic foot ulcers in hospitalized patients based on initial evaluation.

A cross-sectional study was conducted in the Endocrinology department, Hayatabad Medical Complex Peshawar, Pakistan, from June 26, 2025 to December 26, 2025. Consecutive sampling was used to cover 108 individuals who had been admitted with DFU. Clinical, laboratory, and demographic information was gathered, including the duration of diabetes, Wagner grade, peripheral pulses, HbA1c, total leukocyte count (TLC), X-ray foot findings and vascular assessment. Clinical outcomes were divided into four categories: below-knee amputation (BKA), forefoot/ mid foot amputation, toe amputation, and conservative care. Data were analyzed by using Chi-square tests and multinomial logistic regression (p ≤ 0.05).

Most patients were male (63%) and aged 41-70 years (85.2%). Diabetes duration >10 years was present in 63.9% and poor glycemic control (HbA1c >7.5%) was observed in 90.8% of patients. Wagner grade and X-ray evidence of osteomyelitis was significantly associated with poorer outcomes (p <0.001 and p=0.027 respectively). Multinomial regression identified Wagner grade had the strongest association with the amputation (BKA: OR 6.50; TOE: OR 3.12). X-ray findings were independently related to toe amputation (OR 0.33).

Initial ulcer severity and bone involvement on X-ray strongly predict amputation in hospitalized patients. Timely identification and aggressive treatment of severe ulcers may reduce limb loss.