Analysis of Risk Factors for Amputation in Patients with Diabetic Foot Ulcers: a Cohort Study from a Tertiary Center

Overview

Journal Acta Orthop Traumatol Turc

Specialties Emergency Medicine
Orthopedics

Date 2022 Oct 17

PMID 36250877

Authors

Denizhan Demirkol

Samil Aktas

Tuncay Ozcan

Xavier Tannier

Cigdem Selcukcan Erol

Affiliations

Soon will be listed here.

Abstract

Objective: This study aimed to analyze risk factors for amputation (overall, minor and major) in patients with diabetic foot ulcers (DFUs).

Methods: 407 patients with DFUs (286 male, 121 female; mean age = 60, age range = 32-92) who were managed in a tertiary care centre from 2009 to 2019 were retrospectively identified and included in the study. DFUs were categorized based on the Meggit-Wagner, PEDIS, S(AD)SAD, and University of Texas (UT) classification systems. To identify amputation risk-related factors, results of patients with DFUs who underwent amputations (minor or major) were compared to those who received other adjunctive treatments using Chi-Square, oneway analysis of variance (ANOVA) and Spearman correlation analysis.

Results: The mean C-reactive protein (CRP) and White Blood Cell (WBC) values were significantly higher in patients with major or minor amputation than in those without amputation. The mean Neutrophil (PNL), Platelets (PLT), wound width, creatinine and sedimentation (ESR) values were significantly higher in patients with major amputation compared to other groups of patients. Elevated levels of Highdensity lipoprotein (HDL), Hemoglobin (HGB) and albumin were determined to be protective factors against the risk of amputation. Spearman correlation analysis revealed a positive-sided, strong-levelled, significant relation between Wagner grades and amputation status of patients.

Conclusion: This study has identified specific factors for major and minor amputation risk of patients with DFUs. Especially infection markers such as CRP, WBC, ESR and PNL were higher in the amputation group. Most importantly, Meggit Wagner, one of the four different classification systems used in the DFUs, was determined to be highly associated with patients' amputation risk.

Level Of Evidence: Level IV, Prognostic Study.

Citing Articles

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The incidence of lower extremity amputation and its associated risk factors in patients with diabetic foot ulcers: A meta-analysis.

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Prediction of amputation risk of patients with diabetic foot using classification algorithms: A clinical study from a tertiary center.

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PMID: 38272802 PMC: 10789580. DOI: 10.1111/iwj.14556.

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Zhu Y, Xu H, Wang Y, Feng X, Liang X, Xu L Int Wound J. 2023; 20(10):4050-4060.

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