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. 2020 Jun 8;9(6):1780.
doi: 10.3390/jcm9061780.

Prevalence, Clinical Aspects and Outcomes in a Large Cohort of Persons with Diabetic Foot Disease: Comparison between Neuropathic and Ischemic Ulcers

Marco Meloni  1 , Valentina Izzo  1 , Laura Giurato  1 , José Luis Lázaro-Martínez  2 , Luigi Uccioli  1
Affiliations

Prevalence, Clinical Aspects and Outcomes in a Large Cohort of Persons with Diabetic Foot Disease: Comparison between Neuropathic and Ischemic Ulcers

Marco Meloni et al. J Clin Med. .

Abstract

This study aims to evaluate clinical and ulcer characteristics as well the outcomes of patients with diabetic foot ulcers (DFUs). The study group was composed of DFUs patients managed by a limb salvage protocol according to guidance. Clinical and ulcers findings were described, and 1-year outcomes defined as limb salvage, healing, healing time, major amputation and death were compared between neuropathic and ischemic DFUs. One thousand, one hundred and ninety-eight subjects were included; 386 (32.2%) neuropathic and 812 (67.8%) ischemic DFUs. Neuropathic patients were younger (69.5 ± 11.5 vs. 74.5 ± 11.5, p < 0.0001) and reported less cases of nephropathy (22.8 vs. 39.6%, p < 0.0001), ischemic heart disease (22.8 vs. 36.9, p = 0.0004), cerebrovascular disease (8.3 vs. 17.2%, p = 0.002), heart failure (10.1 vs. 24.7%, p = 0.0002) and end-stage-renal-disease (ESRD) (5.4 vs. 27%, p = 0.0001) than ischemic patients; they also showed less cases of large (>5 cm2) (10.3 vs. 22.9%, p = 0.0007), infected (40.4 vs. 55.7%, p = 0.0005) and deep to the bone (22.3 vs. 39.2, p = 0.0002) ulcers, as well less multiple ulcerations (21.8 vs. 32.8%, p = 0.006) than patients with ischemic DFUs. The outcomes for neuropathic and ischemic DFUs were limb salvage (98.4 vs. 82.3%, p < 0.0001), healing (97.3 vs. 79.6%, p < 0.0001), healing time (34.9 vs. 35.6 weeks, p = 0.8), major amputation (0.5 vs. 6.6%, p = 0.0001), death (1.1 vs. 11%, p < 0.0001) respectively. Revascularization failure and ESRD were independent predictors of major amputation, while heart failure and number of co-morbidities (³5) were independent predictors of death. Ischemic DFUs patients showed more severe clinical and ulcers features as well worse outcomes than neuropathic DFUs patients.

Keywords: amputation; co-morbidities; diabetes; diabetic foot ulcers; wound healing.

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Conflict of interest statement

The authors declare no conflict of interest.

Figures

Figure 1
Figure 1
Outcome of all subjects, neuropathic and ischemic/neuro-ischemic patients.
See this image and copyright information in PMC

References

    1. Meloni M., Izzo V., Giurato L., Uccioli L. The Diabetic Foot Syndrome. Volume 26. Karger; Basel, Switzerland: 2018. A complication of the complications: The complexity of pathogenesis and the role of co-morbidities in the diabetic foot syndrome. Frontiers in Diabetes.
    1. Reiber G.E., Boyko E.J., Smith D.G. Diabetes in America. 2nd ed. US Government Printing Office; Washington, DC, USA: 1995. Lower extremity foot ulcers and amputations in diabetes; pp. 409–428. NIH Publication. Chapter 18.
    1. Frykberg R.G., Haabershaw G.M., Chrzan J.S. Contemporary Endocrinology. Volume 7. Humana Press; Totowa, NJ, USA: 1998. Epidemiology of the diabetic foot: Ulcerations and amputations; pp. 273–290. Clinical Management of Diabetic Neuropathy.
    1. Armstrong D.G., Swerdlow M.A., Armstrong A.A., Conte M.S., Padula W.V., Bus S.A. Five year mortality and direct costs of care for people with diabetic foot complications are comparable to cancer. J. Foot Ankle Res. 2020;13:16. doi: 10.1186/s13047-020-00383-2. - DOI - PMC - PubMed
    1. Jeyaraman K., Berhane T., Hamilton M., Chandra A.P., Falhammar H. Mortality in patients with diabetic foot ulcer: A retrospective study of 513 cases from a single Centre in the Northern Territory of Australia. BMC Endocr. Disord. 2019;19:1. doi: 10.1186/s12902-018-0327-2. - DOI - PMC - PubMed

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