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

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.

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

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. 

scholarly journals Predictors of lower extremity amputation in patients with diabetic foot ulcer

2019 ◽  
Vol 6 (4) ◽  
pp. 1208
Author(s):  
Girish Thimmanalli Umashankar ◽  
Anil Kumar M. S. ◽  
Mohammed Shahid
Keyword(s):  
Risk Factors ◽  
Lower Extremity ◽  
Diabetic Foot ◽  
Classification System ◽  
Adverse Outcome ◽  
Foot Ulcer ◽  
Diabetic Foot Ulcer ◽  
Lower Extremity Amputation ◽  
Assessment Model ◽  
Extremity Amputation

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.

scholarly journals Lower-Extremity Amputation Risk After Charcot Arthropathy and Diabetic Foot Ulcer

Diabetes Care ◽  
2009 ◽  
Vol 33 (1) ◽  
pp. 98-100 ◽  
Author(s):  
M.-W. Sohn ◽  
R. M. Stuck ◽  
M. Pinzur ◽  
T. A. Lee ◽  
E. Budiman-Mak
Keyword(s):  
Lower Extremity ◽  
Diabetic Foot ◽  
Foot Ulcer ◽  
Diabetic Foot Ulcer ◽  
Lower Extremity Amputation ◽  
Charcot Arthropathy ◽  
Extremity Amputation

scholarly journals Predictors of Lower-Extremity Amputation in Patients With an Infected Diabetic Foot Ulcer

Diabetes Care ◽  
2015 ◽  
Vol 38 (5) ◽  
pp. 852-857 ◽  
Author(s):  
Kristy Pickwell ◽  
Volkert Siersma ◽  
Marleen Kars ◽  
Jan Apelqvist ◽  
Karel Bakker ◽  
...  
Keyword(s):  
Lower Extremity ◽  
Diabetic Foot ◽  
Foot Ulcer ◽  
Diabetic Foot Ulcer ◽  
Lower Extremity Amputation ◽  
Extremity Amputation

scholarly journals The importance of HbA1C and erythrocyte sedimentation rate as prognostic factors in predicting the outcome of diabetic foot ulcer disease

2017 ◽  
Vol 4 (1) ◽  
pp. 137
Author(s):  
Pal Bikramjit ◽  
Nagaraju Raveender ◽  
Pal Sudipta
Keyword(s):  
Lower Extremity ◽  
Hospital Stay ◽  
Diabetic Foot ◽  
Foot Ulcer ◽  
Diabetic Foot Ulcer ◽  
Lower Extremity Amputation ◽  
Prolonged Hospital Stay ◽  
Ulcer Disease ◽  
Prolonged Hospital ◽  
Extremity Amputation

Background: The study is to determine the relation between the high HbA1c and ESR as prognostic factors with the severity of the diabetic foot ulcer disease, particularly, in predicting the final outcome in the form of higher incidence of lower extremity amputation (LEA) and/or prolonged hospital stay. The study explored the importance of increased level of serum HbA1c and erythrocyte sedimentation rate (ESR) in determining the final outcome of the disease. It revealed that the severity of diabetic foot ulcer disease is more in patients who had concomitant high levels of baseline HbA1c and ESR on admission.Methods: This observational study was done in 89 patients who were admitted in the surgical wards of the two teaching hospitals in India. The cohort consisted of patients from the age of 26 to 83 years of age who presented with clinically infected foot ulcers. Routine blood tests were done which include HbA1C on the day of admission and fasting ESR (1st hour) on the next day morning. The standard X-ray plates were routinely taken on the first day for determination of the involvement of underlying bones and soft tissues. The outcome of the diabetic foot ulcer was assessed from the severity of the disease according to Meggit-Wagner classification, the incidence of lower extremity amputation and the duration of hospital stay.Results: The high levels of baseline HbA1C (more than 7.0%) in blood on the first day of admission was found in all of the 89 patients who were included in this study but the criteria for consideration of high risk was more than 9% which was found in 41 patients. The criteria for consideration of high ESR in this study was set to be 50 mm/h. High ESR of more than 50 mm was found in 63 patients. We had subdivided 31 patients into a High Risk Group whose baseline levels of HbA1C > 9% and ESR > 50 mm/h. The incidence of amputation was 79.31% and 44.44% with HbA1c of more than 9.0% and ESR of more than 50 mm respectively and was considerably increased (83.87%) when both HbA1c and ESR were more than the critical value as set in the study. Similarly, the incidence of prolonged hospital stay of more than 14 days was 58.54% in patients with HbA1C level of greater than 9 %, 51.85% in patients with baseline ESR > 50 mm/h and 93.55% in presence of high levels of both HbA1C (>9%) and ESR (>50 mm/h)..Conclusions: The study observed that the patients who presented with baseline high levels of HbA1C, ESR or both on admission had unfavourable prognosis with increased incidence of lower extremity amputation and prolonged hospital stay than the other patients in the cohort. 

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