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. 2014 Sep-Oct;28(5):632-8.
doi: 10.1016/j.jdiacomp.2014.04.011. Epub 2014 Apr 24.

The independent contribution of diabetic foot ulcer on lower extremity amputation and mortality risk

Daniela Martins-Mendes  1 , Matilde Monteiro-Soares  2 , Edward John Boyko  3 , Manuela Ribeiro  4 , Pedro Barata  5 , Jorge Lima  6 , Raquel Soares  7
Affiliations

The independent contribution of diabetic foot ulcer on lower extremity amputation and mortality risk

Daniela Martins-Mendes et al. J Diabetes Complications. 2014 Sep-Oct.

Abstract

Aims: To estimate 3-year risk for diabetic foot ulcer (DFU), lower extremity amputation (LEA) and death; determine predictive variables and assess derived models accuracy.

Material and methods: Retrospective cohort study including all subjects with diabetes enrolled in our diabetic foot outpatient clinic from beginning 2002 until middle 2010. Data were collected from clinical records.

Results: 644 subjects with mean age of 65.1 (±11.2) and diabetes duration of 16.1 (±10.8) years. Cumulative incidence was 26.6% for DFU, 5.8% for LEA and 14.0% for death. In multivariate analysis, physical impairment, peripheral arterial disease complication history, complication count and previous DFU were associated with DFU; complication count, foot pulses and previous DFU with LEA and age, complication count and previous DFU with death. Predictive models' areas under the ROC curves ranged from 0.80 to 0.83. A simplified model including previous DFU and complication count presented high accuracy. Previous DFU was associated with all outcomes, even when adjusted for complication count, in addition to more complex models.

Conclusions: DFU seems more than a marker of complication status, having independent impact on LEA and mortality risk. Proposed models may be applicable in healthcare settings to identify patients at higher risk of DFU, LEA and death.

Keywords: Diabetes; Diabetic Foot; Foot ulcer; Mortality; Prediction.

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Figures

Figure 1
Figure 1
Receiver operating characteristic curve of predictive models for diabetic foot ulcer (a), lower extremity amputation (b) and death (c) occurrence
Figure 2
Figure 2
Receiver operating characteristic curve of predictive models for diabetic foot ulcer (a), lower extremity amputation (b) and death (c) occurrence using only complication count and previous diabetic foot ulcer
Figure 3
Figure 3
Causes of death ESRD: End-Stage Renal Disease ICD-9 codes verified Infection 52, 421, 464, 466, 480–488, 490–508, 519, 590, 595, 681, 682, 785 Oncologic 151, 153, 154, 157, 161, 162, 171–174, 185, 188, 189, 191, 203 Heart failure 428 ESRD 250.4, 585 Stroke 434, 436 Myocardial infarction 410 Trauma 800–804, 820–829
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