Predictors of lower extremity amputation in patients with diabetic foot ulcer

Background: Diabetic foot lesions are responsible for more hospitalisations than any other complication of diabetes and diabetes is a predominant aetiology for non-traumatic lower extremity amputations. Authors, therefore, examined the clinical characteristics that best predict poor outcome in a large population of diabetic foot ulcer patients. The objective of the study was to describe independent predictors for lower extremity amputation in patients with a diabetic foot ulcer and to validate the predictive value of PEDIS (IWGDF) classification system for a diabetic foot ulcer.Methods: A retrospective study of 197 patients presenting with diabetic foot ulcer presenting to a tertiary care hospital in Mysuru, India. The recorded parameters were age, sex, various risk factors, laboratory parameters, the presence of DM-related complications and ulcer characteristics as determined by PEDIS system. The main outcomes recorded were healed ulcer and amputation.Results: Authors have found that factors strongly associated with risk of amputation are (in order of strength): PVD, past amputation, nephropathy, past ulcer, ulcer duration, TLC, Hb and sr. creatinine. Authors also validated the PEDIS scoring system as an effective classification system with prognostic value. The PEDIS score of >7 is a highly significant predictor of adverse outcome (amputation) of diabetic foot ulcer.Conclusions: Several risk factors for lower extremity amputation in a patient with diabetic foot ulcer were identified. An integrated risk-assessment model including the above significant risk factors and PEDIS system can be developed that is both clinically accurate as well as quick to assess for predicting the adverse outcome in a patient of diabetic foot ulcer and providing an opportunity to save the limb.

Download Full-text

Risk Factors for Lower Extremity Amputation in Diabetic Foot Ulcer Patients: A Case-Control Study

JUXTA: Jurnal Ilmiah Mahasiswa Kedokteran Universitas Airlangga ◽

10.20473/juxta.v11i22020.83-85 ◽

2020 ◽

Vol 11 (2) ◽

pp. 83

Author(s):

Gusti Agung Ayu Ira Kencana Dewi ◽

Sony Wibisono ◽

I Putu Alit Pawana

Keyword(s):

Risk Factors ◽

Lower Extremity ◽

Diabetic Foot ◽

Medical Records ◽

Foot Ulcer ◽

Diabetic Foot Ulcer ◽

Lower Extremity Amputation ◽

History Of ◽

Extremity Amputation ◽

Control Study

Introduction: Diabetes mellitus is a metabolic syndrome that is marked by higher blood glucose. The uncontrolled high blood glucose can lead to complication, such as diabetic foot. Diabetic foot is the most reason why diabetic patients are hospitalized. Diabetic foot that cannot heal may lead to lower extremity amputation. The purpose of this study was to describe the risk factors of lower extremity amputation in diabetic foot ulcer patients.Methods: This study used a case-control study of diabetic foot patients in Dr. Soetomo General Hospital from January 2015 to December 2017. This study used the data from medical records in Inpatient Installation Department of Internal Medicine. Patients with diabetic foot ulcer and lower extremity amputation due to diabetes were included in this study. Incomplete medical records were excluded. Data of samples were divided to two groups, i.e. the amputation group and the non-amputation group with a ratio of 1:1. Risk factors of amputation that were analyzed were male, old age, and the history of ulcer/lower extremity amputation.Results: Based on the data of 36 samples, there were 11 male patients (61.1%) and 7 female patients (38.9%) who experienced lower extremity amputation. The average age of amputation group was 59.61 years old with a range of ages from 39 to 72 years old. This study found the risk factors for lower extremity amputation in diabetic foot ulcer patients was the history of ulcer/amputation due to diabetes (OR 5.0, 95% CI 1.065-23.464, p = 0.034). Conclusion: The risk factor for lower extremity amputation in diabetic foot ulcer patients was the history of ulcer/amputation due to diabetes.

Download Full-text

Implementation of diabetic foot ulcer classification system for research purposes to predict lower extremity amputation

International Journal of Diabetes in Developing Countries ◽

10.4103/0973-3930.50707 ◽

2009 ◽

Vol 29 (1) ◽

pp. 1 ◽

Cited By ~ 19

Author(s):

MohamedE Ahmed ◽

AbuBakrH Widatalla ◽

Seif ElDinI Mahadi ◽

MohamedA Shawer ◽

HagirA Elsayem

Keyword(s):

Lower Extremity ◽

Diabetic Foot ◽

Classification System ◽

Foot Ulcer ◽

Diabetic Foot Ulcer ◽

Lower Extremity Amputation ◽

Extremity Amputation

Download Full-text

Risk Factors for Lower Extremity Amputation in Patients with Diabetic Foot Ulcer

Pressure Injury, Diabetes and Negative Pressure Wound Therapy - Recent Clinical Techniques, Results, and Research in Wounds ◽

10.1007/15695_2017_47 ◽

2017 ◽

pp. 109-142

Author(s):

Tjokorda Gde Dalem Pemayun ◽

Ridho M. Naibaho

Keyword(s):

Risk Factors ◽

Lower Extremity ◽

Diabetic Foot ◽

Foot Ulcer ◽

Diabetic Foot Ulcer ◽

Lower Extremity Amputation ◽

Extremity Amputation

Download Full-text

Predictive risk factors for lower limb amputations in patients with diabetic foot ulcer in correlation with Wagner’s grading

International Surgery Journal ◽

10.18203/2349-2902.isj20214748 ◽

2021 ◽

Vol 8 (12) ◽

pp. 3576

Author(s):

Ambikavathy Mohan ◽

Saideep Ravura ◽

Kumar Srinivasan

Keyword(s):

Risk Factors ◽

Lower Extremity ◽

Diabetic Foot ◽

Foot Ulcer ◽

Diabetic Foot Ulcer ◽

Lower Extremity Amputation ◽

Diabetic Patients ◽

Team Approach ◽

Multidisciplinary Team Approach ◽

Extremity Amputation

Background: Lower extremity amputation in diabetic patients results in high morbidity causing poor quality of life despite high medical expenses. A correlate of risk factors with Wagner‘s grading of foot ulcers and their improvement with multidisciplinary team approach would form a basis for preventive diabetic foot care guidelines in health care policy. Objectives of current study were to assess the risk factors and role of multidisciplinary team approach in patients undergoing lower extremity amputations with diabetic footulcer with different Wagner‘s grading.Methods: Prospective data of diabetic patients above eighteen years with foot ulcers admitted in departments of general surgery/general medicine at Vydehi Institute of medical sciences and research centre, between October 2017 to October 2019 were included. Multi-disciplinary treatment approach was adopted and treated accordingly. Patients were followed up for three months to reassess the risk factors for lower extremity amputation and correlated with Wagner‘s grading system and analyzed using descriptive statistical analysis, SPSS-21.Results: fifty patients with Wagner’s grade 1-4 of which forty four (88%) males and six (12%) females. Four (8%) of the patients underwent major limb amputation. 18% underwent minor amputation and 16% SSG. 54% were grade 3,4 on day 1 and 24% patients were grade 3, 4 and 5 after 3 months of follow up (p=0.034).Conclusions: Clinical assessment of diabetic foot ulcer and identification of risk factors for the nonhealing predicts the favourable outcome in the management of diabetic foot combined with multi-disciplinary team approach strategy.

Download Full-text