The Association Between Prognoses And Glycemic Control Level Or Secondary PA Infection In Patients With Diabetic Foot Ulcers

Objectives: Considerable advances regarding diabetic foot ulcers(DFUs)have been achieved,however,the optimal glycemic control level for DFU is still controversial.It’s certain that DFU infection such as Pseudomonas aeruginosa(PA)infection would exert adverse impacts on related outcomes,but whether secondary PA infection would worsen the outcomes was still unknown.Our studies aimed to detect the effects of glycemic control and secondary PA infection on prognoses in patients with DFU.Methods: Hospitalized DFU patients excluding those with severe comorbidities were recruited consecutively,with their microorganism culture results,Hb A1 c values as well as other clinical data collected.These patients were followed-up to observe the outcomes,including ulcer healing and death.The associations between glycemic control level or secondary PA infection and wound healing as well as mortality were evaluated in univariate and multivariate Logistic regression models.Results: 1.To investigate the association between glycemic control level and outcomes,298 patients with DFU were enrolled.During the one year follow-up period,40(13.4%)individuals died and 168(56.4%)achieved ulcer healing.Both univariate regression analysis and multivariate regression analysis showed no significant relationship between baseline Hb A1 c and DFU healing.After adjusting,sex,BMI,Wagner grade,history of amputation,peripheral neuropathy,e GFR category,history of smoking,serum albumin level,wound healing rate was higher(OR=2.01,95%CI: 1.02-3.96,P <0.05)when Hb A1 c controlled between 7.0% and 8.0% during treatment compared to Hb A1 c controlled less than 7.0%.This probability of ulcer healing increased to 3.01 folds(OR=3.01,95%CI: 1.32-6.86,P=0.01)after adjusted in subgroup with baseline Hb A1 c no more than 8.0%.Neither baseline Hb A1 c nor mean Hb A1 c during treatment presented any correlation with one-year death rate.2.For analyzing the effects of secondary PA infection on outcomes,48 patients with secondary PA infection of DFU were enrolled,and 78 patients with primary PA infection of DFU were taken as control.During the 2 year follow-up period,14(29.2%)died and 21(43.8%)achieved ulcer healing in group with secondary PA infection,9(11.5%)died and 55(70.5%)achieved ulcer healing in control group.After adjusting for age,sex,Wagner grade,the risk of ulcer healing failure within 2 years increased(OR=3.03,95%CI: 1.18-7.77,P=0.03)for patients with secondary PA infection compared with those without,and the risk of death was also higher(OR=2.52,95%CI: 1.08-5.88,P=0.04).Decreased plasma albumin level(P=0.04)and prolonged duration of DFU(P=0.01)were independent risk factors of secondary PA infection in patients with DFU.Conclusions: A Hb A1 c target between 7.0% and 8.0% during treatment could facilitate ulcer healing without increase of mortality in patients with DFU,especially for those with better glycemic control at admission.Secondary PA infection made DFU less likely to be healed and also raised the risk of death for patients with DFU.