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Meta-Analysis
. 2024 Jul;21(7):e14931.
doi: 10.1111/iwj.14931.

The incidence of lower extremity amputation and its associated risk factors in patients with diabetic foot ulcers: A meta-analysis

Yinli Luo  1   2 , Chang Liu  2 , Chuying Li  2 , Meitong Jin  1   2 , Longquan Pi  2 , Zhehu Jin  1   2
Affiliations
Meta-Analysis

The incidence of lower extremity amputation and its associated risk factors in patients with diabetic foot ulcers: A meta-analysis

Yinli Luo et al. Int Wound J. 2024 Jul.

Abstract

This study analysed the incidence of lower extremity amputation and its associated risk factors in patients with diabetic foot ulcers. This study systematically searched both Chinese and English databases, including CNKI, Wanfang, VIP, PubMed, EMBASE and Web of Science, to identify cohort studies related to lower extremity amputation and associated risk factors in patients with diabetic foot ulcers up to October 2023. The patients were stratified based on whether they underwent lower extremity amputation, and relevant data, including basic information, patient characteristics, complications, comorbidities and pertinent laboratory test data, were extracted from the included studies. The literature quality assessment in this study utilized the Newcastle-Ottawa Scale to screen for high-quality literature, resulting in the inclusion of 16 cohort studies, all of which were of at least moderate quality. Meta-analysis of outcome indicators was conducted using the Stata 14.0 software. The results indicate that the overall amputation rate of lower extremities in patients with diabetic foot ulcers is 31% (0.25, 0.38). Among the 16 variables evaluated, gender (male), smoking history, body mass index (BMI), hypertension, cardiovascular disease, kidney disease, white blood cell count, haemoglobin and albumin levels were found to be correlated with the occurrence of lower extremity amputation in patients with diabetic foot ulcers. However, no significant correlation was observed between age, diabetes type, duration of diabetes, stroke, glycosylated haemoglobin, creatinine and total cholesterol levels and lower extremity amputation in patients with diabetic foot ulcers. This meta-analysis indicates that the overall amputation rate in patients with diabetic foot ulcers is 31%. Factors such as gender (male), smoking history, high BMI, hypertension, cardiovascular disease, kidney disease, white blood cell count, haemoglobin and albumin levels are identified as significant risk factors for lower extremity amputation in diabetic foot ulcer patients. These findings suggest that attention should be focused on these risk factors in patients with diabetic foot ulcers to reduce the risk of lower extremity amputation. Therefore, preventive and intervention measures targeting these risk factors are of significant importance in clinical practice. (Systematic review registration: https://www.crd.york.ac.uk/PROSPERO/, identifier [CRD42024497538]).

Keywords: diabetes mellitus; diabetic foot ulcer; lower extremity amputation; meta‐analysis; risk factors.

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Conflict of interest statement

The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper.

Figures

FIGURE 1
FIGURE 1
Flow chart showing inclusion and exclusion of literature.
FIGURE 2
FIGURE 2
Meta‐analysis of the incidence of lower extremity amputation (A) forest map, (B) sensitivity analysis map and (C) publication bias funnel map.
FIGURE 3
FIGURE 3
Sensitivity analysis results of (A) hypertension and (B) cardiovascular disease were included in the study.
FIGURE 4
FIGURE 4
Funnel plot including indicators (A) gender, (B) smoking history and publication bias analysis of (C) hypertension.
See this image and copyright information in PMC

References

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