scholarly journals Major Amputation Profoundly Increases Mortality in Patients With Diabetic Foot Infection

2021 ◽  
Vol 8 ◽  
Author(s):  
Miska Vuorlaakso ◽  
Juha Kiiski ◽  
Tapani Salonen ◽  
Matti Karppelin ◽  
Mika Helminen ◽  
...  
Keyword(s):  
Diabetic Foot ◽  
Major Amputation ◽  
Older Age ◽  
Hospital Treatment ◽  
Clinical Parameters ◽  
Term Survival ◽  
Free Survival ◽  
Cox Regression Analysis ◽  
Diabetic Foot Infection ◽  
The One

Introduction: An acute diabetic foot infection (DFI) is a serious condition and a leading cause of hospitalization and major amputation in patients with diabetes. Aim of this study was to evaluate the long term survival and risk factors for death and amputation after the DFI requiring hospital treatment.Materials and Methods: A retrospective study included all adult patients hospitalized for DFI treatments during 2010–2014. Overall survival (OS) and amputation free survival (AFS) (without major amputation) was calculated. We performed a Cox regression analysis of several clinical parameters to evaluate the effects of clinical parameters on overall and amputation-free survival.Results: Total of 324 patients with mean age of 66.8 (SD 12.8) years were included. The one- and five-year OS after DFI 81.2% (95%CI 77.5–84.9%) and 49.7% (95%CI 44.8–54.6%), respectively. Major amputation, wound ischemia, older age, and a low glomerular filtration rate reduced the OS after DFI. After a major amputation, the one- and five-year OS was 41.7% (95%CI 13.9–69.5) and 8.3% (95%CI 0.0–24.0%), respectively. Wound ischemia, older age, and elevated C-reactive protein reduced AFS. In contrast, hypertensive medication use was identified as a protective factor.Conclusion: Mortality after a DFI remains high and is significantly increased after a major amputation. Findings highlight the importance of early wound and ischemia management for DFI prevention.

Outcomes after Emergency Admission with a Diabetic Foot Attack Indicate a High Rate of Healing and Limb Salvage But Increased Mortality: 18-Month Follow-up Study

2020 ◽  
Author(s):  
Erika Vainieri ◽  
Raju Ahluwalia ◽  
Hani Slim ◽  
Daina Walton ◽  
Chris Manu ◽  
...  
Keyword(s):  
Limb Salvage ◽  
Diabetic Foot ◽  
Emergency Admission ◽  
Arterial Disease ◽  
Major Amputation ◽  
Outcome Data ◽  
High Rate ◽  
Free Survival ◽  
Peripheral Arterial

Abstract Aim The diabetic foot attack (DFA) is perhaps the most devastating form of diabetic foot infection, presenting with rapidly progressive skin and tissue necrosis, threatening both limb and life. However, clinical outcome data in this specific group of patients are not available. Methods Analysis of 106 consecutive patients who underwent emergency hospitalisation for DFA (TEXAS Grade 3B or 3D and Infectious Diseases Society of America (IDSA) Class 4 criteria). Outcomes evaluated were: 1) Healing 2) major amputation 3) death 4) not healed. The first outcome reached in one of these four categories over the follow-up period (18.4±3.6 months) was considered. We also estimated amputation free survival. Results Overall, 57.5% (n=61) healed, 5.6% (n=6) underwent major amputation, 23.5% (n=25) died without healing and 13.2% (n=14) were alive without healing. Predictive factors associated with outcomes were: Healing (age<60, p=0.0017; no Peripheral arterial disease (PAD) p= 0.002; not on dialysis p=0.006); major amputation (CRP>100 mg/L, p=0.001; gram+ve organisms, p=0.0013; dialysis, p= 0.001), and for death (age>60, p= 0.0001; gram+ve organisms p=0.004; presence of PAD, p=0.0032; CRP, p=0.034). The major amputation free survival was 71% during the first 12 months from admission, however it had reduced to 55.4% by the end of the follow-up period. Conclusions In a unique population of hospitalised individuals with DFA, we report excellent healing and limb salvage rates using a dedicated protocol in a multidisciplinary setting. An additional novel finding was the concerning observation that such an admission was associated with high 18-month mortality, almost all of which was after discharge from hospital.

The Effects of Antimicrobial Resistance and the Compatibility of Initial Antibiotic Treatment on Clinical Outcomes in Patients With Diabetic Foot Infection

2021 ◽  
pp. 153473462110041
Author(s):  
Nese Saltoglu ◽  
Serkan Surme ◽  
Elif Ezirmik ◽  
Ayten Kadanali ◽  
Ahmet Furkan Kurt ◽  
...  
Keyword(s):  
Multivariate Analysis ◽  
Antimicrobial Resistance ◽  
Clinical Outcomes ◽  
Diabetic Foot ◽  
Initial Treatment ◽  
Methicillin Resistance ◽  
Major Amputation ◽  
Diabetic Foot Infection ◽  
Vascular Insufficiency ◽  
Klebsiella Spp

We aimed to determine pathogen microorganisms, their antimicrobial resistance patterns, and the effect of initial treatment on clinical outcomes in patients with diabetic foot infection (DFI). Patients with DFI from 5 centers were included in this multicenter observational prospective study between June 2018 and June 2019. Multivariate analysis was performed for the predictors of reinfection/death and major amputation. A total of 284 patients were recorded. Of whom, 193 (68%) were male and the median age was 59.9 ± 11.3 years. One hundred nineteen (41.9%) patients had amputations, as the minor (n = 83, 29.2%) or major (n = 36, 12.7%). The mortality rate was 1.7% with 4 deaths. A total of 247 microorganisms were isolated from 200 patients. The most common microorganisms were Staphylococcus aureus (n = 36, 14.6%) and Escherichia coli (n = 32, 13.0%). Methicillin resistance rates were 19.4% and 69.6% in S aureus and coagulase-negative Staphylococcus spp., respectively. Multidrug-resistant Pseudomonas aeruginosa was detected in 4 of 22 (18.2%) isolates. Extended-spectrum beta-lactamase-producing Gram-negative bacteria were detected in 20 (38.5%) isolates of E coli (14 of 32) and Klebsiella spp. (6 of 20). When the initial treatment was inappropriate, Klebsiella spp. related reinfection within 1 to 3 months was observed more frequently. Polymicrobial infection ( p = .043) and vancomycin treatment ( p = .007) were independent predictors of reinfection/death. Multivariate analysis revealed vascular insufficiency ( p = .004), hospital readmission ( p = .009), C-reactive protein > 130 mg/dL ( p = .007), and receiving carbapenems ( p = .005) as independent predictors of major amputation. Our results justify the importance of using appropriate narrow-spectrum empirical antimicrobials because higher rates of reinfection and major amputation were found even in the use of broad-spectrum antimicrobials.

scholarly journals Systemic inflammatory response syndrome as a predictor of poorer outcomes in diabetic foot infection: a prospective analytical study

2020 ◽  
Vol 7 (6) ◽  
pp. 1830
Author(s):  
Anand Vinay Karnawat ◽  
Vijayakumar Chellappa ◽  
Balasubramanian Gopal ◽  
Rajkumar Nagarajan ◽  
Krishnamachari Srinivasan
Keyword(s):  
Systemic Inflammatory Response Syndrome ◽  
Inflammatory Response ◽  
Hospital Stay ◽  
Diabetic Foot ◽  
Major Amputation ◽  
Systemic Inflammatory Response ◽  
Microbial Culture ◽  
Diabetic Foot Infection ◽  
Culture Duration ◽  
Time Of Presentation

Background: This study was done to diagnose the severity of infection in a group of hospitalized diabetic foot infection (DFI) patients based on the presence or absence of systemic inflammatory response syndrome (SIRS) and compare the outcomes.Methods: This was a single-center cohort study, in which 50 consecutive DFI patients having SIRS and 50 consecutive patients not having SIRS were included. Patients were followed for the duration of the hospital stay; parameters for glycaemic control, minor and major amputation, microbial culture, duration of hospital and ICU stay and mortality was recorded.Results: The relative risk of major amputation among the patients of DFI who presented with SIRS was 2.66 times higher compared to who was not having SIRS at presentation (95% CI, 1.56-4.55). The presence of polymicrobial infection also had a statistically significant association with the incidence of major amputation. The duration of hospital stay was ~9.5 days longer in the DFI patients who presented with SIRS compared to who was not having SIRS at the time of presentation [8.00 (4.00-20.50) days versus 17.50 (10.75-38.25) days]. DFI patients with SIRS required a significantly prolonged ICU.Conclusions: SIRS can be used as objective criteria to predict poorer outcomes in the diabetic foot infection patient and also to classify it. 

scholarly journals Procalcitonin Is a Prognostic Marker of Hospital Outcomes in Patients with Critical Limb Ischemia and Diabetic Foot Infection

2019 ◽  
Vol 2019 ◽  
pp. 1-5 ◽  
Author(s):  
Marco Meloni ◽  
Valentina Izzo ◽  
Laura Giurato ◽  
Enrico Brocco ◽  
Michele Ferrannini ◽  
...  
Keyword(s):  
Limb Salvage ◽  
Critical Limb Ischemia ◽  
Diabetic Foot ◽  
Univariate Analysis ◽  
Limb Ischemia ◽  
Major Amputation ◽  
Diabetic Patients ◽  
Hospital Outcomes ◽  
Diabetic Foot Infection ◽  
The Mean

Aim. To evaluate the prognostic role of procalcitonin (PCT) in patients with diabetic foot infection (DFI) and critical limb ischemia (CLI). Materials and Methods. The study group was composed of diabetic patients with DFI and CLI. All patients were treated according to a preset limb salvage protocol which includes revascularization, wound debridement, antibiotic therapy, and offloading. Inflammatory markers, including PCT, were evaluated at admission. Only positive values of PCT, greater than 0.5 ng/ml, were considered. Hospital outcomes were categorized as limb salvage (discharge with preserved limb), major amputation (amputation above the ankle), and mortality. Results. Eighty-six patients were included. The mean age was 67.3±11.4 years, 80.7% were male, 95.1% had type 2 diabetes, and the mean diabetes duration was 20.5±11.1 with a mean HbA1c of 67±16 mmol/mol. 66/86 (76.8%) of patients had limb salvage, 7/86 (8.1%) had major amputation, and 13/86 (15.1%) died. Patients with positive PCT baseline values in comparison to those with normal values showed a lower rate of limb salvage (30.4 versus 93.6%, p=0.0001), a higher rate of major amputation (13 versus 6.3%, p=0.3), and a higher rate of hospital mortality (56.5 versus 0%, p<0.0001). At the multivariate analysis of independent predictors found at univariate analysis, positive PCT was an independent predictor of major amputation [OR 3.3 (CI 95% 2.0-5.3), p=0.0001] and mortality [OR 4.1 (CI 95% 2.2-8.3), p<0.0001]. Discussion. Positive PCT at admission increased the risk of major amputation and mortality in hospital patients with DFI and CLI.

scholarly journals Clinical characteristics and blood/serum bound prognostic biomarkers in advanced pancreatic cancer treated with gemcitabine and nab-paclitaxel

2020 ◽  
Author(s):  
Hakon Blomstrand ◽  
Henrik Green ◽  
Mats Fredriksson ◽  
Emma Gränsmark ◽  
Bergthor Björnsson ◽  
...  
Keyword(s):  
Pancreatic Cancer ◽  
Regression Analysis ◽  
Serum Albumin ◽  
Blood Serum ◽  
Advanced Pancreatic Cancer ◽  
Progression Free Survival ◽  
Older Age ◽  
Baseline Serum ◽  
Free Survival ◽  
Cox Regression Analysis

Abstract Background: In recent years treatment options for advanced pancreatic cancer has markedly improved, and a combination regimen of gemcitabine and nab-paclitaxel is now considered standard of care in Sweden and elsewhere. Nevertheless, a majority of patients do not respond to treatment. In order to guide the individual patient to the most beneficial therapeutic strategy, simple and easily available prognostic and predictive markers are needed. Methods: The potential prognostic value of a range of blood/serum parameters, patient-, and tumour characteristics was explored in a retrospective cohort of 75 patients treated with gemcitabine/nab-paclitaxel (Gem/NabP) for advanced pancreatic ductal adenocarcinoma (PDAC) in the South Eastern Region of Sweden. Primary outcome was overall survival while progression free survival was the key secondary outcome.Result: Univariable Cox regression analysis revealed that high baseline serum albumin (> 37 g/L) and older age (>65) were positive prognostic markers for OS, and in multivariable regression analysis both parameters were confirmed to be independent prognostic variables (HR 0.48, p=0.023 and HR=0.47, p=0.039,). Thrombocytopenia at any time during the treatment was an independent predictor for improved progression free survival (PFS) but not for OS (HR 0.49, p=0.029, 0.54, p=0.073), whereas thrombocytopenia developed under cycle 1 was neither related with OS nor PFS (HR 0.87, p=0.384, HR 1.04, p=0.771). Other parameters assessed (gender, tumour stage, ECOG performance status, myelosuppression, baseline serum CA19-9, and baseline serum bilirubin levels) were not significantly associated with survival. Conclusion: Serum albumin at baseline is a prognostic factor with palliative Gem/NabP in advanced PDAC, and should be further assessed as a tool for risk stratification. Older age was associated with improved survival, which encourages further studies on the use of Gem/NabP in the elderly.

Long Term Survival after ASCT for AML: Multivariate Analysis Shows Adverse Effect of Collecting and Infusing Larger Numbers of CD 34 Positive Cells.

Blood ◽  
2005 ◽  
Vol 106 (11) ◽  
pp. 2921-2921
Author(s):  
Clarence B. Sarkodee-Adoo ◽  
Anthony S. Stein ◽  
Margaret R. O’Donnell ◽  
Ravi M. Bhatia ◽  
E. Bolotin ◽  
...  
Keyword(s):  
Conditioning Regimen ◽  
Model Fit ◽  
P Value ◽  
Event Free Survival ◽  
Relapse Free Survival ◽  
Term Survival ◽  
Free Survival ◽  
Cox Regression Analysis ◽  
Cd 34 ◽  
Probability Of Death

Abstract INTRODUCTION: The major cause of failure after ASCT for AML in 1st remission is relapse. The collection/ infusion of more CD 34 + cells results in earlier engraftment, but its effect on relapse rates is unknown. METHODS: Between 2/95 and 9/03, 87 patients with AML in 1st CR underwent ASCT on two sequential IRB-approved trials. Patients with APL, high-risk cytogenetics, or intermediate-risk cytogenetics and a sibling donor were preferentially treated on alternative protocols. Patients received two cycles of ara C (3 g/m2/12h x 8) and idarubicin 12mg/m2/d x 3 (one cycle ara C 2g/m2/12h x 8 if age 55–60). (Nine patients did not receive idarubicin).The 2nd cycle, followed by GCSF 10ug/kg, served as mobilization. All collected cells were infused. Conditioning utilized TBI/VP-16/cyclophosphamide (n = 47) or (AUC-targeted) busulfan/TBI/VP-16 (n = 40). Remission status (morphology; flow cytometry; normal cytogenetics) was confirmed in bone marrow samples prior to mobilization. RESULTS: 5- year survival rates were 72% (95% CI 62–81%) overall and 68% (95% CI 56–77%) event-free (figure). Mobilization yielded 4.07 x 106 CD 34+ cells/kg (median; range 1.1– 45.08 x 106). Engraftment to ANC 500/ul occurred at 11 days (median; range 8–22), and to (non-transfused) platelet count of 20,000/ul at 22 days (median; range 7–183). In multivariable Cox regression analysis (model fit p-value 0.0007), earlier engraftment was associated with high versus standard dose ara C induction (1.77 times faster; p = 0.02), and graft CD 34+ cell content (1.06 times faster per 106 /kg; p = 0.001). By multivariable Cox proportional-hazards regression, (model fit p-value = 0.01) the number of CD 34+ cells collected/ infused and the time between remission and consolidation were both predictive of shorter event-free survival. An increase of 106 in the number of CD34+ cells was associated with a 1.06 factor increase in the probability of death or relapse (95% CI 1, 1.11, p = 0.04). Each month’s delay between remission and consolidation increased the probability of death or relapse by a factor of 1.22 (95% CI 1.02, 1.47, p = 0.03). The leukocyte count at diagnosis was associated with longer event-free survival (0.98 times per 1000 cells/ul), (95% CI 0.96, 1.00, p = 0.05). Age, sex, the presence of extramedullary disease, FAB subtype, cytogenetic risk group, type (high versus conventional dose ara-C) and number of induction cycles, use of idarubicin in consolidation, conditioning regimen, and IL-2 administration after transplant were not correlated with survival or event-free survival. CONCLUSION: In this study, the collection and infusion of more CD 34+ cells resulted in shortened relapse-free survival, despite an initial favorable impact on engraftment times. Longer time between remission and consolidation also adversely influenced relapse-free survival. Figure Figure

scholarly journals Efficacy of diabetic ulcer severity score in patients with diabetic foot ulcer in predicting prognosis

2021 ◽  
Vol 8 (10) ◽  
pp. 2961
Author(s):  
Robinson George ◽  
Joe Mathew ◽  
Vishnu M. L. ◽  
Jacob P. Thomas
Keyword(s):  
Diabetic Foot ◽  
Severity Score ◽  
Scoring System ◽  
Foot Ulcer ◽  
Diabetic Foot Ulcer ◽  
Arterial Disease ◽  
Major Amputation ◽  
Classification Systems ◽  
Clinical Parameters ◽  
Diabetic Ulcer

Background: Diabetic foot ulcer (DFU) is a full-thickness wound, skin necrosis or gangrene below the ankle induced by peripheral neuropathy or peripheral arterial disease in patients with diabetes. There are well-accepted classification systems for DFUs, namely Wagner’s scoring system, university of Texas scoring system etc. However, only few are scientifically validated. Diabetic ulcer severity score (DUSS) introduced by Beckert et al consists of easily accessible clinical parameters which categorizes wounds into specific subgroups for comparison of outcomes.Methods: A prospective study was conducted on 250 diabetic ulcer patients, attending the out-patient department (OPD) of surgery, Pushpagiri institute of medical sciences, Tiruvalla.Results: Most common age group affected with diabetic foot was between 51-60 years (mean 58.9±10.2 years). Males accounted for 54% of patients. Most common ulcers were of score of 2 followed by score 3. Overall, 105 (42%) of 250 people had amputations in our study with majority undergoing minor amputation (30%) than the major amputation (12%). None of the patients with scores 0, 1 and 2 had major amputation. Probability of healing among the various scores were-100% for score 0, 97.9% for score 1, 83.4% for score 2, 17.7% for score 3 and 4.8% for score 4. Lower score is strongly associated with primary healing and higher score with amputations.Conclusions: DUSS system is an easy wound based diagnostic tool for anticipating probability of healing or amputation and need for surgery by assessing the four clinical parameters and combining them which is safe and easily reproducible.

scholarly journals The first experience of gene therapy for the complex treatment of no-option chronic limb-threatening ischemia

2020 ◽  
Vol 24 (4) ◽  
pp. 83
Author(s):  
Yu. V. Chervyakov ◽  
H. N. Ha
Keyword(s):  
Gene Therapy ◽  
Ulcer Healing ◽  
Conflicts Of Interest ◽  
Survival Rates ◽  
Total Mortality ◽  
Major Amputation ◽  
Free Survival ◽  
One Year ◽  
The One

<p><strong>Aim.</strong> To evaluate the effects of complex treatments with no-option chronic limb-threatening ischemia patients with ulcers, using plasmid-based vascular endothelial growth factor-165 (VEGF-165) gene therapy in a one year follow-up period.</p><p><strong>Methods.</strong> In total, 43 patients with no-option chronic limb-threatening ischemia were enrolled in a one year follow-up study. All patients received standard conservative treatment in combination with gene therapy. The mean patient age was 68.0 ± 9.8 years; 65 % men and 35 % women. Patients were divided into four subgroups according to WIfI (Wound, Ischemia, and foot Infection) combinations: 130 — 37 % (n = 16); 131 — 21 % (n = 9); 230 — 21 % (n = 9), and 231 — 21 % (n = 9). Effectiveness criteria were set at major amputation rates, amputation-free survival rates, total mortality, and rates of ulcer healing in the one year follow-up period.</p><p><strong>Results.</strong> Major amputation rates, amputation-free survival rates, total mortality, and rates of ulcer healing during the one year follow-up were; 28, 63, 12 and 51 %, respectively. Separately, a subgroup of WIfI 130 combination patients experienced significant improvements (p = 0.01): amputation-free survival — 94 %, limb salvage rates — 100 %, and rate of ulcer healing — 88 %.</p><p><strong>Conclusion.</strong> Using a plasmid-based VEGF-165 gene therapy approach in the subgroup with the WIfI 130 combination was beneficial. Gene therapy was not effective in patients with large ulcer areas and depth, and local infections (subgroups; 230 and 231). The higher WIfI combinations led to an increase in major amputation rates, reduced amputation-free survival and ulcer healing rates. Total mortality was independently not associated with ulcer area and depth, and severity of local infection. Total mortality between subgroups 130, 131, 230, 231 for WIfI combinations during 1 year of follow-up was not statistically differences (log-rank test, p = 0.67)</p><p>Received 2 June 2020. Revised 16 October 2020. Accepted 28 October 2020.</p><p><strong>Conflict of interest:</strong> Authors declare no conflicts of interest.</p><p><strong>Funding:</strong> The study did not have sponsorship.</p>

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