Risk Factors for Major Amputation in Diabetic Foot Ulcer Patients

Background: The purpose of our study was to identify the new and the more specific risk factors for major amputation in patients with diabetic foot ulcer (DFU).

Methods: We used data from the Electronic Medical Record (EMR) database of our hospital from February 2014 to July 2020. Patients with DFU and amputation were included in the study. The logistic regression model was adjusted for demographic characteristics and related comorbidities between major and minor amputation groups.

Results: Among 3654 patients with DFU, 363 (9.9%) were amputated. Patients with major versus minor amputation, in multivariable logistic regression models, major amputation independent factors included previous amputation history (odds ratio [OR] 2.31 [95% CI 1.17-4.53], = 0.02), smoking (2.58 [1.31-5.07], = 0.01), coronary artery disease (CAD) (2.67 [1.35-5.29], = 0.03), ankle brachial index (ABI) <0.4 (15.77 [7.51-33.13], < 0.01), Wagner 5 (5.50 [1.89-16.01], < 0.01), activated partial thromboplastin time (APTT) (1.23 [1.03-1.48], = 0.01), glycosylated hemoglobin A1c (HbA1c) (1.23 [1.03-1.48], = 0.03), hemoglobin (Hb) (0.98 [0.96-1.00], = 0.01), plasma albumin (ALB) (0.88 [0.81-0.95], < 0.01) and white blood cell (WBC) (1.10 [1.04-1.16], < 0.01).

Conclusion: Major amputation was associated with previous amputation history, smoking, CAD, Wagner 5, ABI <0.4, HbA1c, Hb, ALB, WBC, and APTT might be a new independent factor. In view of these factors, early prevention and guidance promptly orientated by multidisciplinary is of great significance to reduce the disability rate and economic burden.