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. 2017 Mar;31(3):556-561.
doi: 10.1016/j.jdiacomp.2016.11.020. Epub 2016 Dec 10.

Diabetic foot ulcer severity predicts mortality among veterans with type 2 diabetes

Meghan B Brennan  1 , Timothy M Hess  2 , Brian Bartle  3 , Jennifer M Cooper  4 , Jonathan Kang  5 , Elbert S Huang  6 , Maureen Smith  7 , Min-Woong Sohn  8 , Christopher Crnich  2
Affiliations

Diabetic foot ulcer severity predicts mortality among veterans with type 2 diabetes

Meghan B Brennan et al. J Diabetes Complications. 2017 Mar.

Abstract

Aim: Diabetic foot ulcers are associated with an increased risk of death. We evaluated whether ulcer severity at presentation predicts mortality.

Methods: Patients from a national, retrospective, cohort of veterans with type 2 diabetes who developed incident diabetic foot ulcers between January 1, 2006 and September 1, 2010, were followed until death or the end of the study period, January 1, 2012. Ulcers were characterized as early stage, osteomyelitis, or gangrene at presentation. Cox proportional hazard regression identified independent predictors of death, controlling for comorbidities, laboratory parameters, and healthcare utilization.

Results: 66,323 veterans were included in the cohort and followed for a mean of 27.7months: 1-, 2-, and 5-year survival rates were 80.80%, 69.01% and 28.64%, respectively. Compared to early stage ulcers, gangrene was associated with an increased risk of mortality (HR 1.70, 95% CI 1.57-1.83, p<0.001). The magnitude of this effect was greater than diagnosed vascular disease, i.e., coronary artery disease, peripheral arterial disease, or stroke.

Conclusion: Initial diabetic foot ulcer severity is a more significant predictor of subsequent mortality than coronary artery disease, peripheral arterial disease, or stroke. Unrecognized or under-estimated vascular disease and/or sepsis secondary to gangrene should be explored as possible causal explanations.

Keywords: Diabetes; Foot ulcer; Gangrene; Mortality; Vascular disease.

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Figures

Figure 1
Figure 1
Timeline depicting rolling cohort study design.
Figure 2
Figure 2
Kaplan-Meier survival curves following incident diabetic foot ulcer diagnosis, stratified by ulcer severity.
See this image and copyright information in PMC

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