Evaluating Classification Systems of Diabetic Foot Ulcer Severity: A 12-Year Retrospective Study on Factors Impacting Survival

Abstract

(1) Background: This study examines the survival of patients after their first presentation with diabetic foot ulcers (DFUs) to the regional Diabetes, Nutrition, and Metabolic Diseases Clinic within the Emergency Clinical Hospital "Sf. Spiridon", Iaşi, and analyzes the factors associated with this outcome. (2) Methods: In this retrospective study, patients with DFUs consecutively referred between 1 January 2007 and 31 December 2017 were followed up until 31 December 2020 (for 13 years). The study group included 659 subjects. (3) Results: During the study period, there were 278 deaths (42.2%) and the average survival time was 9 years. The length of hospitalization, diabetic nephropathy, chronic kidney disease, glomerular filtration rate, cardiovascular disease, hypertension, anemia, and DFU severity were the most significant contributors to the increase in mortality. Patients with severe ulcers, meaning DFUs involving the tendon, joint, or bone, had a higher mortality risk than those with superficial or pre-ulcerative lesions on initial presentation (Texas classification HR = 1.963, 95% CI: 1.063-3.617; Wagner-Meggitt classification HR = 1.889, 95% CI: 1.024-3.417, SINBAD Classification System and Score HR = 2.333, 95% CI: 1.258-4.326) after adjusting for confounding factors. (4) Conclusions: The findings of this study suggested that patients presenting with severe ulcers involving the tendon, joint, or bone exhibited a significantly higher risk of mortality, even when potential confounders were taken into consideration.

Keywords: SINBAD classification system and score; University of Texas Staging System; Wagner–Meggitt classification; diabetic foot ulcers; mortality; survival.

Figure 1

Flow chart of the selection of participants.

Figure 2

Survival curve of patients with DFUs.

Figure 3

Kaplan–Meier curves for survival ((A) diabetic nephropathy; (B) cardiovascular disease; (C) University of Texas classification; (D) Wagner–Meggitt classification; (E) Saint Elian Wound Score System; (F) SINBAD Classification System and Score; (G) WIfI Classification System).