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. 2023 Jan;20(1):173-182.
doi: 10.1111/iwj.13861. Epub 2022 Jun 8.

Risk factors for foot ulcer recurrence in patients with comorbid diabetic foot osteomyelitis and diabetic nephropathy: A 3-year follow-up study

Li Zhang  1 , Guifen Fu  2 , Yongqing Deng  3 , Yuechou Nong  1 , Jianhao Huang  1 , Xiulu Huang  1 , Fenglian Wei  1 , Yanqing Yu  1 , Litian Huang  1 , Wenjiao Zhang  1 , Meizhu Tang  1 , Licai Deng  1 , Jiaxia Han  1 , Xing Zhou  1 , Qiu Wang  1 , Wensheng Lu  1
Affiliations

Risk factors for foot ulcer recurrence in patients with comorbid diabetic foot osteomyelitis and diabetic nephropathy: A 3-year follow-up study

Li Zhang et al. Int Wound J. 2023 Jan.

Abstract

This study aimed to explore the risk factors for foot ulcer recurrence in patients with comorbid diabetic foot osteomyelitis (DFO) and diabetic nephropathy (DN). This is a prospective cohort study. Between May 2018 and May 2021, we selected 120 inpatients with comorbid severe diabetic foot infection (PEDIS Grade 3 or above) and DN for inclusion in our study. All cases were followed up for 36 months. The study outcomes were whether foot ulcer recurred and the time to recurrence. The risk factors of ulcer recurrence were analysed by comparing the data of the three groups. According to the recurrence of foot ulcer, the participants were divided into three groups: Group A (no foot ulcer recurrence, n = 89), Group B (foot ulcer recurrence within 12-36 months, n = 19) and Group C (foot ulcer recurrence within 6-12 months, n = 12). The multivariate Cox regression analysis showed that urine albumin-creatinine ratio (UACR) (HR: 1.008, 95% CI: 1.005-1.011, P < .001) and vibration perception threshold (VPT) (HR: 1.064, 95% CI: 1.032-1.096, P < .001) were identified as independent risk factors. Kaplan-Meier curves showed a significant positive association between UACR or VPT and the risk of foot ulcer recurrence (log rank, all P < .05). Areas under the ROC curves for UACR, VPT and the combination of UACR and VPT were 0.802, 0.799 and 0.842, respectively. The best cut-off values of UACR and VPT were 281.51 mg/g and 25.12 V, respectively. In summary, elevated UACR and VPT were independent risk factors. The best clinical cut-off values of UACR and VPT for prediction of foot ulcer recurrence were 281.51 mg/g and 25.12 V, respectively. Besides, our results suggested that microcirculation disorders rather than macrovascular complications play a major role in the recurrence of foot ulcer in patients with comorbid DFO and DN.

Keywords: diabetic foot; diabetic nephropathy; foot ulcer recurrence; influencing factors.

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Conflict of interest statement

The authors declare no conflicts of interest.

Figures

FIGURE 1
FIGURE 1
The dynamics of foot ulcer healing during the treatment. (A) Foot ulcer before treatment. (B) The wounds were treated with wound dressing change and negative pressure wound therapy. (C) The wounds after 14 days treatment. (D) The healing of the ulcer after treatment
FIGURE 2
FIGURE 2
Kaplan‐Meier curves of the cumulative incidence of ulcer recurrence stratified by urine albumin‐creatinine ratio (UACR) levels
FIGURE 3
FIGURE 3
Kaplan‐Meier curves of the cumulative incidence of ulcer recurrence stratified by vibration perception threshold (VPT) levels
FIGURE 4
FIGURE 4
Receiver‐operator characteristic (ROC) curve of urine albumin‐creatinine ratio (UACR) and vibration perception threshold (VPT) for the risk prediction of foot ulcer recurrence
See this image and copyright information in PMC

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