Risk Factors For Amputation And Wound Healing In Diabetic Foot Patients

Objectives:To evaluate the epidemiology of the diabetic foot and the predictive factors for amputation and the risk factors for wound healing.Methods:1.This is a prospective study of 116 patients treated in our hospital during the period of December the 31st 2007 to October the first 2008.A protocol was designed for documentation including patient profile,comorbidities and complications,clinical presentations,and final outcome.2.Predicators for limb loss were determined using univariate and stepwise logistic regression analysis.3. Kaplan-Meier analysis was used to estimate the median healing time,Cox regression analysis was used to assess the ability of the various factors to predict healing within the study period.Results:1.A total of 116 patients with diabetic foot entered the study during the period of December the 31st 2007 to October the first 2008.The group comprised 70 males and 46 females,the mean(±SD) age and the duration of diabetes was 64.5±10.8 and 12.1±8.2 years,respectively.The median estimated duration of diabetic foot at the time of first assessment was 30 days.More than half of the patients had hypertension,coronary heart disease,diabetic nephropathy,diabetic retinopathy,peripheral arterial disease and diabetic perineuropathy,more than one quarter of the patients in the group had cerebrovascular disease.2.22.4%patients WB＞10~9/l,82.8%patients hs-CRP>3g/l,7.8%patients ALB<30g/l,87.1%patients HbAlc>7%.The most important infectious micro-organism was Staphylococcus epidermidis(21.3%),followed by staphylococcus aureus(17.6%),pseudomonas aeruginosa(11.1%) and Bacillus Citrobacter(10.2%).3.The group was comprised of 77 diabetic ulcers and 39 circumscribed gangrenes.The most frequent(53.2%) lesion site was toes and metatarsophalangeal joint.28.4%of the patients with Neuropathic foot,8.6%of the patients with ischemic foot,and 49.1%of the patients with neuroischaemic foot.There were 107 patients with foot infection,38 patients with severe infection.4.There were 38(32.8%) patients amputated in the hospital,And 6(5.2%) patients among them amputated above ankle(2 of them were amputated initiated because of the severe infection,the other 4 Patients were amputated again after the minor amputation)。Significant associations were observed in the univariate analysis between hs-CRP,WBC,ALB,TG,gender,PAD,DNP,severe infection, gangrene,lesion site(toes and metatarsophalangeal joint) and the amputation. Multivariate and stepwise logistic regression analysis showed that the PAD,severe infection,gangrene,lesion site(toes and metatarsophalangeal joint) were the risk factors for amputation of DF patients.5.36 patients had minor amputation,the wound healing rate in hospital was 66.7%,the twice major amputation rate above ankle was 11.1%,the death rate was 8.3%.The healing time lasted from 27 days to 158 days,the median healing time was 67 days,the healing rate within three month was 50%,and the healing rate within sixth month was 66.7%.Kaplan-Meier analysis discovered that there were significant associations between PAD,severe infection before amputation,diabetic nephropathy,amputation of more than two toes and wound healing.Cox regression analysis found that the PAD,severe infection before amputation,and amputation of more than two toes were the independent risk factors for wound healing.Conclusion:1.There were many old male patients in the group,the duration of diabetes and diabetes foot were long.Many DF patients had complications.There were many patients with gangrene,the most frequent lesion site was the toes and metatarsophalangeal joint,92.2%percents of the lesion was infected.2.The amputation rate was high(33.8%),the healing speed of the wound was slowly(the median wound healing time was 67 days),PAD,severe infection,gangrene,lesion site(toes and metatarsophalangeal joint) were the risk factors for amputation; ABI＜0.7,severe infection before amputation,and amputation of more than two toes were the independent risk factors for wound healing.The patients with the risk factors for amputation and wound healing should be found combined with actively treatment.