Predictors of lower extremity amputation in patients with diabetic foot ulcer: findings from MEDFUN, a multi-center observational study
Abstract Background Lower extremity amputation (LEA) is a potential sequelae of diabetic foot ulceration (DFU) and is associated with huge morbidly and mortality. Low and middle income countries are currently at the greatest risk of diabetes-related complications and deaths. We sought to identify de...
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| Format: | Article |
| Language: | English |
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Wiley
2019-06-01
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| Series: | Journal of Foot and Ankle Research |
| Subjects: | |
| Online Access: | http://link.springer.com/article/10.1186/s13047-019-0345-y |
| _version_ | 1797225610414653440 |
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| author | Ejiofor Ugwu Olufunmilayo Adeleye Ibrahim Gezawa Innocent Okpe Marcelina Enamino Ignatius Ezeani |
| author_facet | Ejiofor Ugwu Olufunmilayo Adeleye Ibrahim Gezawa Innocent Okpe Marcelina Enamino Ignatius Ezeani |
| author_sort | Ejiofor Ugwu |
| collection | DOAJ |
| description | Abstract Background Lower extremity amputation (LEA) is a potential sequelae of diabetic foot ulceration (DFU) and is associated with huge morbidly and mortality. Low and middle income countries are currently at the greatest risk of diabetes-related complications and deaths. We sought to identify demographic, clinical and laboratory variables that significantly predict LEA in patients hospitalized for DFU. Methods The Multi-center Evaluation of Diabetic Foot Ulcer in Nigeria (MEDFUN) was an observational study conducted between March 2016 and April 2017 in six tertiary healthcare institutions. We prospectively followed 336 diabetic patients hospitalized for DFU and managed by a multidisciplinary team until discharge or death. Demographic and diabetes-related information and ulcer characteristics were documented. Patients were evaluated for neuropathy, peripheral arterial disease (PAD) and medical co-morbidities while relevant laboratory and imaging tests were performed. The study end-points were ulcer healing, LEA, duration of hospitalization and mortality. Here we present data on amputation. Results One hundred and nineteen subjects (35.4%) underwent LEA during the follow-up period. Univariate predictors of LEA were ulcer duration more than 1 month prior to hospitalization (P < 0.001), PAD (P < 0.001), Wagner grade ≥ 4 (P < 0.001), wound infection (P 0.041), Proteinuria (P 0.021), leucocytosis (P 0.001) and osteomyelitis (P < 0.001). On multivariate regression, only three variables emerged as significant independent predictors of LEA and these include: ulcer duration more than 1 month (O.R. 10.3, 95% C.I. 4.055–26.132), PAD (O.R. 2.8, 95% C.I. 1.520–5.110) and presence of osteomyelitis (O.R. 5.6, 95% C.I. 2.930–10.776). Age, gender, diabetes type and duration, neuropathy, glycemic control and anemia did not predict LEA in the studied population. Conclusion We identified duration of ulcer greater than 1 month, PAD, Wagner grade 4 or higher, proteinuria, leucocytosis, wound infection and osteomyelitis as the significant predictors of LEA in patients hospitalized for DFU. Prompt attention to these risk factors may reduce amputation rate among these patients. |
| first_indexed | 2024-03-08T07:25:03Z |
| format | Article |
| id | doaj.art-43e9bef22c32439096958e137b81571b |
| institution | Directory Open Access Journal |
| issn | 1757-1146 |
| language | English |
| last_indexed | 2024-04-24T14:11:45Z |
| publishDate | 2019-06-01 |
| publisher | Wiley |
| record_format | Article |
| series | Journal of Foot and Ankle Research |
| spelling | doaj.art-43e9bef22c32439096958e137b81571b2024-04-03T09:01:43ZengWileyJournal of Foot and Ankle Research1757-11462019-06-011211810.1186/s13047-019-0345-yPredictors of lower extremity amputation in patients with diabetic foot ulcer: findings from MEDFUN, a multi-center observational studyEjiofor Ugwu0Olufunmilayo Adeleye1Ibrahim Gezawa2Innocent Okpe3Marcelina Enamino4Ignatius Ezeani5Department of Medicine, Division of Endocrinology, Diabetes and Metabolism, Enugu State University of Science and TechnologyDepartment of Medicine, Division of Endocrinology, Diabetes and Metabolism, Lagos State UniversityDepartment of Medicine, Division of endocrinology, Diabetes and Metabolism, Bayero UniversityDepartment of Medicine, Division of Endocrinology, Diabetes and Metabolism, Ahmadu Bello UniversityDepartment of Medicine, Division of Endocrinology, Diabetes and Metabolism, Federal Medical CenterDepartment of Medicine, Division of Endocrinology, Diabetes and Metabolism, Federal Medical CenterAbstract Background Lower extremity amputation (LEA) is a potential sequelae of diabetic foot ulceration (DFU) and is associated with huge morbidly and mortality. Low and middle income countries are currently at the greatest risk of diabetes-related complications and deaths. We sought to identify demographic, clinical and laboratory variables that significantly predict LEA in patients hospitalized for DFU. Methods The Multi-center Evaluation of Diabetic Foot Ulcer in Nigeria (MEDFUN) was an observational study conducted between March 2016 and April 2017 in six tertiary healthcare institutions. We prospectively followed 336 diabetic patients hospitalized for DFU and managed by a multidisciplinary team until discharge or death. Demographic and diabetes-related information and ulcer characteristics were documented. Patients were evaluated for neuropathy, peripheral arterial disease (PAD) and medical co-morbidities while relevant laboratory and imaging tests were performed. The study end-points were ulcer healing, LEA, duration of hospitalization and mortality. Here we present data on amputation. Results One hundred and nineteen subjects (35.4%) underwent LEA during the follow-up period. Univariate predictors of LEA were ulcer duration more than 1 month prior to hospitalization (P < 0.001), PAD (P < 0.001), Wagner grade ≥ 4 (P < 0.001), wound infection (P 0.041), Proteinuria (P 0.021), leucocytosis (P 0.001) and osteomyelitis (P < 0.001). On multivariate regression, only three variables emerged as significant independent predictors of LEA and these include: ulcer duration more than 1 month (O.R. 10.3, 95% C.I. 4.055–26.132), PAD (O.R. 2.8, 95% C.I. 1.520–5.110) and presence of osteomyelitis (O.R. 5.6, 95% C.I. 2.930–10.776). Age, gender, diabetes type and duration, neuropathy, glycemic control and anemia did not predict LEA in the studied population. Conclusion We identified duration of ulcer greater than 1 month, PAD, Wagner grade 4 or higher, proteinuria, leucocytosis, wound infection and osteomyelitis as the significant predictors of LEA in patients hospitalized for DFU. Prompt attention to these risk factors may reduce amputation rate among these patients.http://link.springer.com/article/10.1186/s13047-019-0345-yDiabetesFoot ulcerRisk factorsAmputationPredictorsMEDFUN |
| spellingShingle | Ejiofor Ugwu Olufunmilayo Adeleye Ibrahim Gezawa Innocent Okpe Marcelina Enamino Ignatius Ezeani Predictors of lower extremity amputation in patients with diabetic foot ulcer: findings from MEDFUN, a multi-center observational study Journal of Foot and Ankle Research Diabetes Foot ulcer Risk factors Amputation Predictors MEDFUN |
| title | Predictors of lower extremity amputation in patients with diabetic foot ulcer: findings from MEDFUN, a multi-center observational study |
| title_full | Predictors of lower extremity amputation in patients with diabetic foot ulcer: findings from MEDFUN, a multi-center observational study |
| title_fullStr | Predictors of lower extremity amputation in patients with diabetic foot ulcer: findings from MEDFUN, a multi-center observational study |
| title_full_unstemmed | Predictors of lower extremity amputation in patients with diabetic foot ulcer: findings from MEDFUN, a multi-center observational study |
| title_short | Predictors of lower extremity amputation in patients with diabetic foot ulcer: findings from MEDFUN, a multi-center observational study |
| title_sort | predictors of lower extremity amputation in patients with diabetic foot ulcer findings from medfun a multi center observational study |
| topic | Diabetes Foot ulcer Risk factors Amputation Predictors MEDFUN |
| url | http://link.springer.com/article/10.1186/s13047-019-0345-y |
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