Journal of Yeungnam Medical Science

Yeungnam University College of Medicine, Yeungnam University Institute Medical Science (영남대 의대 학술지 편집위원회)
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Risk factors affecting amputation in diabetic foot

  • Lee, Jun Ho (Republic of Korea Army) ;
  • Yoon, Ji Sung (Division of Endocrinology and Metabolism, Department of Internal Medicine, Yeungnam University College of Medicine) ;
  • Lee, Hyoung Woo (Division of Endocrinology and Metabolism, Department of Internal Medicine, Yeungnam University College of Medicine) ;
  • Won, Kyu Chang (Division of Endocrinology and Metabolism, Department of Internal Medicine, Yeungnam University College of Medicine) ;
  • Moon, Jun Sung (Division of Endocrinology and Metabolism, Department of Internal Medicine, Yeungnam University College of Medicine) ;
  • Chung, Seung Min (Division of Endocrinology and Metabolism, Department of Internal Medicine, Yeungnam University Hospital) ;
  • Lee, Yin Young (Division of Endocrinology and Metabolism, Department of Internal Medicine, Yeungnam University Hospital)
  • Received : 2020.03.04
  • Accepted : 2020.04.14
  • Published : 2020.10.31
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Abstract

Background: A diabetic foot is the most common cause of non-traumatic lower extremity amputations (LEA). The study seeks to assess the risk factors of amputation in patients with diabetic foot ulcers (DFU). Methods: The study was conducted on 351 patients with DFUs from January 2010 to December 2018. Their demographic characteristics, disease history, laboratory data, ankle-brachial index, Wagner classification, osteomyelitis, sarcopenia index, and ulcer sizes were considered as variables to predict outcome. A chi-square test and multivariate logistic regression analysis were performed to test the relationship of the data gathered. Additionally, the subjects were divided into two groups based on their amputation surgery. Results: Out of the 351 subjects, 170 required LEA. The mean age of the subjects was 61 years and the mean duration of diabetes was 15 years; there was no significant difference between the two groups in terms of these averages. Osteomyelitis (hazard ratio [HR], 6.164; 95% confidence interval [CI], 3.561-10.671), lesion on percutaneous transluminal angioplasty (HR, 2.494; 95% CI, 1.087-5.721), estimated glomerular filtration rate (eGFR; HR, 0.99; 95% CI, 0.981-0.999), ulcer size (HR, 1.247; 95% CI, 1.107-1.405), and forefoot ulcer location (HR, 2.475; 95% CI, 0.224-0.73) were associated with risk of amputation. Conclusion: Osteomyelitis, peripheral artery disease, chronic kidney disease, ulcer size, and forefoot ulcer location were risk factors for amputation in diabetic foot patients. Further investigation would contribute to the establishment of a diabetic foot risk stratification system for Koreans, allowing for optimal individualized treatment.

Keywords

References

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