Risk factors of treatment failure in diabetic foot ulcer patients

Abstract

Background: Some diabetic feet heal without complication, but others undergo amputation due to progressive wounds. This study investigates the risk factors for amputation of diabetic feet.

Methods: A total of 55 patients who visited our institution from 2008 to 2012 were included in the study. The patients with abnormal fasting blood sugar levels, lower leg vascularity, and poor nutrition were excluded from the study group, and the wound states were unified. The patients were categorized into a treatment success group (n=47) and a treatment failure group (n=8), and their hemoglobin A1C (HgA1C), C-reactive protein (CRP), white blood cell count (WBC), and serum creatinine levels were analyzed.

Results: The initial CRP, WBC, and serum creatinine levels in the treatment failure group were significantly higher than that of the treatment success group, and the initial HgA1C level was significantly higher in the treatment success group. The CRP and WBC levels of both groups changed significantly as time passed, but their serum creatinine levels did not.

Conclusions: The initial CRP, WBC, and serum creatinine levels were considered to be risk factors for amputation. Among them, the serum creatinine level was found to be the most important predictive risk factor. Because serum creatinine represents the renal function, thorough care is needed for the feet of diabetic patients with renal impairment.

Keywords: Diabetes complications; Foot ulcer; Risk factors.

Fig. 1

A patient of the treatment failure group (A) The patient had acute renal failure, a diabetic ulcer on the lateral foot, and a bulla on the plantar area. (B) The wound was progressing, and septic conditions occurred. Below-knee amputation was performed to prevent the spread of infection.

Fig. 2

A patient of the treatment success group (A) The patient had a normal level of creatinine and had a necrotic ulcer on the first plantar metatarsal head area. (B) After appropriate debridement and conservative dressing, the wound was completely healed.

Fig. 3

A patient of the treatment success group (A) The picture shows a skin and soft tissue defect on the right foot dorsum due to a diabetic ulcer. (B) The wound did not worsen beyond the foot dorsum, and we decided to treat it with anterolateral thigh fasciocutaneous free flap rather than amputation. (C) The picture shows the wound healing.

Fig. 4

HbA1C findings in the treatment success and failure groups There was no difference in hemoglobin A1C (HgA1C), between the initialand late state in the two groups, and there was no difference between the initial state of the success and failure group.

Fig. 5

WBC findings in the treatment success and failure groups The white blood cell count (WBC) count was significantly lower in the late state than in the initial state of the success group, and it was significantly higher in the late state than in the initial state of the failure group. The WBC count was significantly higher in the initial state of the failure group than in the success group.

Fig. 6

CRP findings in the treatment success and failure groups C-reactive protein (CRP) was significantly lower in the late state than in the initial state of the success group, and it was significantly higher in the late state than in the initial state of the failure group. CRP was significantly higher in the initial state of the failure group than in that of the success group.

Fig. 7

Serum creatinine findings in the treatment success and failure groups The serum creatinine levels showed no differences between the initial and late states in the two groups, but they were significantly higher in the initial state of the failure group than in that of the success group.