Analysis Of Clinical Characteristics And Influencing Factors Of Amputation In Hospitalized Patients With Diabetic Foot Ulcer

ObjectiveDiabetic foot ulcer is one of the most serious complications of diabetes,which is the main reason for hospitalization and amputation.Therefore,this study analyzes the medical records of hospitalized patients with diabetic foot ulcer,and explores the influencing factors of amputation and major amputation,so as to provide guidance for preventing the further development of ulcer and reducing the amputation rate.MethodsDiabetic foot ulcer patients admitted to the Second Affiliated Hospital of Anhui Medical University from December 2015 to December 2019 were selected as study subjects,and the data in the electronic medical record system of patients were collected for retrospective analysis.First of all,the clinical characteristics of patients with diabetic foot ulcer were analyzed,then all patients were divided into amputation group and non-amputation group according to whether they had amputation,and were divided into minor group and major amputation group according to the type of amputation.All data were analyzed by univariate analysis,and the statistically significant variables in univariate analysis were included in multivariate logistic regression analysis.Result1.Clinical characteristics of patients with diabetic foot ulcers: After excluding the unqualified data,a total of 455 patients with diabetic foot ulcer met the requirements,there were 299 males(65.7%)and 156 females(34.3%);age range 28-89 years with the average age was(63.60 ± 10.48);181(39.8%)patients had a history of smoking;159(34.9%)patients had a history of alcohol use;Hospital days ranged from 5 to 142 days,with a median of 24(14,36)days;the duration of diabetes was 10(5,15)days and that of diabetic foot was 20(10,40)days;the frequency of occurrence followed the order toe,plantar,dorsum,ankle,heel.124 patients(27.3%)had a history of ulcer,26 cases(5.7%)had a history of amputation,and 92 cases(20.2%)had a history of revascularization of lower extremities.In the results of bacterial culture of wound secretion,190(41.8%)patients showed no bacterial infection,199(43.7%)patients had single bacterial infection,and 66(14.5%)patients had multiple bacterial mixed infection.The lower extremity artery CTA report showed that 160(35.2%)patients had no arterial stenosis,123(27%)had mild stenosis,54(11.9%)had moderate stenosis,48%(10.5%)had severe stenosis,and 70(15.4%)had lower extremity arterial occlusive disease.The most common comorbidity was hypertension(294 patients(64.6%)),followed by coronary heart disease(113 patients(24.8%)),cerebrovascular disease(103 patients(22.6%)),hemodialysis due to chronic renal failure(67 patients(14.7%);and 147 patients(32.3%)were at nutritional risk.There were 210(46.2%),143(31.4%),102(22.4%)patients with UT systemic grade 1,2,and 3,respectively,and 77(16.9%),127(27.9%),99(21.8%),152(33.4%)patients with UT systemic stage A,B,C,and D,respectively.There were 306 patients(67.3%)healed without amputation and 149 patients(32.8%)were treated by amputation surgery.Among all the patients with amputation,according to different types of amputation,there were 100 cases of minor amputation(67.1%)and 49 cases of major amputation(32.9%).2.Univariate analysis of amputation group and non-amputation group: There were significant differences in body mass index,education level,course of diabetes,maximum area,UT system grade,UT system stage,course of diabetic foot ulcer,degree of arterial stenosis of lower extremities,history of ulcer,toe,secretion bacterial culture,nutritional risk,history of revascularization of lower extremities,coronary heart disease,cerebrovascular disease,hemodialysis,white blood cell count,hemoglobin,lymphocytes,platelets,glutamic oxaloacetic transaminase,neutrophil count,prealbumin,creatinine,albumin,plasma D-dimer,percentage of glycosylated hemoglobin and percentage of glycosylated albumin(P < 0.05).Multivariate logistic regression analysis with amputation as dependent variable: UT system grading(OR=6.702,95%CI:3.715-11.204,P < 0.001),stage D of UT system staging(OR=10.044,95%CI:1.016-89.209,P < 0.043),and ulcers at toe(OR=21.163,95%CI:7.564-55.406,P < 0.001).The degree of lower limb artery stenosis(OR=2.497,95%CI:1.615-3.966,P < 0.001),glycosylated albumin(OR=1.122,95%CI:1.019-1.222,P < 0.023)were the risk factors of amputation,and the history of revascularization of lower extremities(OR=0.298,95%CI:0.116-0.811,P < 0.015)were protective factors of amputation.3.Univariate analysis of the minor and major amputation groups: There were significant differences in ulcer area,UT system stage,stenosis degree of lower extremity arteries,toe,foot sole,bacterial culture results,nutritional risk,coronary heart disease,cerebrovascular disease,white blood cell count,neutrophil count,fasting blood glucose,albumin,glycated albumin,and glycated hemoglobin(P < 0.05).Multivariate logistic regression analysis with major amputation as the dependent variable: nutritional risk(OR = 8.333,95% CI:2.813-24.685,P < 0.001),degree of lower extremity artery stenosis(OR = 3.665,95% CI:2.266-5.927,P < 0.001)were risk factors for major amputation,and ulcers at toe(OR = 0.171,95% CI:0.029-0.995,P = 0.049)were are more likely to cause major amputation.ConclusionsIn order to reduce the amputation rate,patients with diabetic foot ulcers should seek medical treatment in time,use appropriate tools to evaluate the severity and debridement in time,find the lower extremity artery disease as soon as possible,make active diagnosis and treatment,improve the condition of insufficient blood supply,actively control the spread of infection,prevent the further development of ulcers,adjust the blood glucose dynamic stability,and improve the nutritional status.