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Mortality in diabetic patients after lower extremity amputations
C H Tseng1, T Y Tai, C K Chong
1Department of Internal Medicine, National Taiwan University Hospital, Taipei, R.O.C.
Insights
Diabetic patients undergoing lower extremity amputations face high mortality, primarily due to cerebral infarction. Hypertension and coronary heart disease significantly increase the risk of fatal outcomes in these patients.
Area of Science:
- Endocrinology
- Vascular Surgery
- Public Health
Background:
- Lower extremity amputations are a serious complication of diabetes mellitus.
- Understanding mortality factors in diabetic amputees is crucial for improving patient outcomes.
Purpose of the Study:
- To identify prognostic factors and causes of death in Chinese diabetic patients after lower extremity amputations.
- To compare mortality rates and causes with the general population and other ethnic groups.
Main Methods:
- Retrospective review of medical records for 87 diabetic amputees (1982-1991).
- Data collection included demographics, medical history, amputation details, and laboratory values.
- Mortality follow-up via personal contact and government records; causes of death from certificates.
- Univariate and multivariate Cox proportional hazards models were used for analysis.
Main Results:
- 34 out of 87 diabetic amputees died within the study period.
- Cerebral infarction, infection, and diabetes mellitus were the leading causes of death.
- Mortality was 5.95 times higher than the age-comparable Taiwanese population.
- History of hypertension and coronary heart disease were significant predictors of mortality (rate ratios > 2).
Conclusions:
- Post-amputation mortality is significantly elevated in diabetic patients.
- Cerebral infarction is the primary cause of death, differing from cardiovascular disease in Caucasians.
- Hypertension and coronary heart disease are critical prognostic indicators for diabetic amputees.
Abstract:
This study evaluates the prognostic factors and causes associated with mortality in Chinese diabetic patients after lower extremity amputations. Medical records of all diabetic patients admitted to the National Taiwan University Hospital for leg amputations from 1982 to 1991 were reviewed. Demographic data, medical history, amputation levels and admission routines, including fasting plasma glucose, cholesterol, triglycerides, blood urea nitrogen, creatinine, urine protein and electrocardiograms, and bacterial culture done during the admission period were recorded. The vital status of the patients was followed by personal contact and mortality was ascertained from government computer records. The causes of death were recorded according to the death certificates. Univariate analysis and multivariate Cox's proportional hazards model were used to identify the prognostic factors associated with mortality. A total of 87 diabetic amputees, of whom 34 died, were found within this 10-year period. Cerebral infarction, infection and diabetes mellitus were the most commonly reported causes of death. Their calculated mortality was 5.95 times higher than the mortality rate of the age-comparable population in Taiwan. A history of hypertension and coronary heart disease were found to be the best indicators for predicting a fatal outcome with rate ratios of over two-fold. This study shows that post-amputational mortality is high in diabetic patients and that the major cause of death is cerebral infarction. The major cause of death in this study differs from that reported for Caucasians, for whom cardiovascular disease is the most important cause of death.