Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2018 Sep;33(5):952-960.
doi: 10.3904/kjim.2016.165. Epub 2017 Jun 7.

Depth and combined infection is important predictor of lower extremity amputations in hospitalized diabetic foot ulcer patients

Eun-Gyo Jeong  1 , Sung Shim Cho  1 , Sang-Hoon Lee  1 , Kang-Min Lee  1 , Seo-Kyung Woo  1 , Yoongoo Kang  1 , Jae-Seung Yun  1 , Seon-Ah Cha  1 , Yoon-Jung Kim  2 , Yu-Bae Ahn  1 , Seung-Hyun Ko  1 , Jung-Min Lee  1
Affiliations

Depth and combined infection is important predictor of lower extremity amputations in hospitalized diabetic foot ulcer patients

Eun-Gyo Jeong et al. Korean J Intern Med. 2018 Sep.

Abstract

Background/aims: As the prevalence of diabetes mellitus and its complications increase rapidly, diabetic foot ulcers (DFUs), which are a major diabetic complication, are expected to increase. For prevention and effective treatment, it is important to understand the clinical course of DFUs. The aim of this study was to investigate the natural course and predictors of amputation in patients with DFUs who required hospitalization.

Methods: A total of 209 patients with type 2 diabetes, aged 30 to 85 years, who visited emergency department or needed hospitalization due to DFUs were consecutively enrolled from May 2012 to January 2016, by retrospective medical record review. The main outcome was lower extremity amputation (LEA).

Results: Among 192 patients who completed follow-up, 113 patients (58.9%) required LEAs. Compared to patients without amputation, baseline levels of white blood cell counts and C-reactive protein were higher in patients with amputation. In addition, bone and joint involvement was more frequently observed in patients with amputation. Multivariable regression analysis revealed that combined infection (odds ratio [OR], 11.39; 95% confidence interval [CI], 2.55 to 50.93; p = 0.001) and bone or joint involvement (OR, 3.74; 95% CI, 1.10 to 12.70; p = 0.035) were significantly associated with an increased risk of LEA.

Conclusion: The depth of the wound and combined infection of DFU, rather than the extent of the wound, were significant prognostic factors of LEAs in patients with type 2 diabetes.

Keywords: Amputation; Diabetes mellitus; Diabetic foot; Prognosis; Ulcer.

PubMed Disclaimer

Conflict of interest statement

No potential conflict of interest relevant to this article was reported.

Figures

Figure 1.
Figure 1.
Study flow diagram. DFU, diabetic foot ulcer; ED, Emergency Department.
See this image and copyright information in PMC

References

    1. Centers for Disease Control and Prevention . Atlanta (GA): U.S. Department of Health and Human Services; 2014. National diabetes statistics report: estimates of diabetes and its burden in the United States, 2014 [Internet] [cited 2017 Feb 16]. Available from: http://www.cdc.gov/diabetes.
    1. Woodbury MG. Diabetic foot risk assessment. Diabetes Metab Res Rev. 2016;32:376–378. - PubMed
    1. International Diabetes Federation . Brussels (BE): International Diabetes Federation; 2015. IDF Diabetes Atlas, 7th ed [Internet] [cited 2017 Feb 16]. Available from: http://www.diabetesatlas.org.
    1. Centers for Disease Control and Prevention . Cheongju (KR): National Health and Nutrition Examination Survey; 2014. National health and nutrition examination survey, 2014 [Internet] [cited 2017 Feb 16]. Available from: https://knhanes.cdc.go.kr.
    1. Amin N, Doupis J. Diabetic foot disease: from the evaluation of the “foot at risk” to the novel diabetic ulcer treatment modalities. World J Diabetes. 2016;7:153–164. - PMC - PubMed