Archives of Plastic Surgery

Korean Society of Plastic and Reconstructive Surgeons (대한성형외과학회)
권호 표지
DOI QR코드

DOI QR Code

Risk Factors of Treatment Failure in Diabetic Foot Ulcer Patients

  • Lee, Kyung Mook (Department of Plastic and Reconstructive Surgery, Hanyang University Guri Hospital, Hanyang University College of Medicine) ;
  • Kim, Woon Hoe (Department of Plastic and Reconstructive Surgery, Hanyang University Guri Hospital, Hanyang University College of Medicine) ;
  • Lee, Jang Hyun (Department of Plastic and Reconstructive Surgery, Hanyang University Guri Hospital, Hanyang University College of Medicine) ;
  • Choi, Matthew Seung Suk (Department of Plastic and Reconstructive Surgery, Hanyang University Guri Hospital, Hanyang University College of Medicine)
  • Received : 2012.11.27
  • Accepted : 2013.01.02
  • Published : 2013.03.15
Download PDF
⟨ Previous Next ⟩

Abstract

Background Some diabetic feet heal without complication, but others undergo amputation due to progressive wounds. This study investigates the risk factors for amputation of diabetic feet. Methods A total of 55 patients who visited our institution from 2008 to 2012 were included in the study. The patients with abnormal fasting blood sugar levels, lower leg vascularity, and poor nutrition were excluded from the study group, and the wound states were unified. The patients were categorized into a treatment success group (n=47) and a treatment failure group (n=8), and their hemoglobin A1C (HgA1C), C-reactive protein (CRP), white blood cell count (WBC), and serum creatinine levels were analyzed. Results The initial CRP, WBC, and serum creatinine levels in the treatment failure group were significantly higher than that of the treatment success group, and the initial HgA1C level was significantly higher in the treatment success group. The CRP and WBC levels of both groups changed significantly as time passed, but their serum creatinine levels did not. Conclusions The initial CRP, WBC, and serum creatinine levels were considered to be risk factors for amputation. Among them, the serum creatinine level was found to be the most important predictive risk factor. Because serum creatinine represents the renal function, thorough care is needed for the feet of diabetic patients with renal impairment.

Keywords

References

  1. Danaei G, Finucane MM, Lu Y, et al. National, regional, and global trends in fasting plasma glucose and diabetes prevalence since 1980: systematic analysis of health examination surveys and epidemiological studies with 370 country-years and 2.7 million participants. Lancet 2011;378:31-40. https://doi.org/10.1016/S0140-6736(11)60679-X
  2. Heo KB, Kim SM, Jang WI, et al. A clinical study in patients with diabetic gangrene. J Korean Diabetes Assoc 1983;7: 65-70.
  3. Reiber GE, Boyko EJ, Smith DG. Lower extremity foot ulcers and amputation in individuals with diabetes. In: Harris MI, Cowie CC, Stern MP, et al., editors. Diabetes in America. 2nd ed. Washington, DC: National Institute of Diabetes and Digestive and Kidney Diseases; 1995. p. 408-28.
  4. Reiber GE. Epidemiology of foot ulcers and amputations in the diabetic foot. In: Bowker JH, Pfeifer MA, editors. Levin and O'neal's the diabetic foot. St. Louis, MO: Mosby; 2001. p. 13-32.
  5. Pecoraro RE, Reiber GE, Burgess EM. Pathways to diabetic limb amputation: basis for prevention. Diabetes Care 1990; 13:513-21. https://doi.org/10.2337/diacare.13.5.513
  6. Sun JH, Tsai JS, Huang CH, et al. Risk factors for lower extremity amputation in diabetic foot disease categorized by Wagner classification. Diabetes Res Clin Pract 2012;95: 358-63. https://doi.org/10.1016/j.diabres.2011.10.034
  7. Shojaiefard A, Khorgami Z, Larijani B. Independent risk factors for amputation in diabetic foot. Int J Diabetes Dev Ctries 2008;28:32-7. https://doi.org/10.4103/0973-3930.43096
  8. Eneroth M, Apelqvist J, Stenstrom A. Clinical characteristics and outcome in 223 diabetic patients with deep foot infections. Foot Ankle Int 1997;18:716-22. https://doi.org/10.1177/107110079701801107
  9. Yang Y, Ostbye T, Tan SB, et al. Risk factors for lower extremity amputation among patients with diabetes in Singapore. J Diabetes Complications 2011;25:382-6. https://doi.org/10.1016/j.jdiacomp.2011.08.002
  10. Karter AJ, Ferrara A, Liu JY, et al. Ethnic disparities in diabetic complications in an insured population. JAMA 2002; 287:2519-27. https://doi.org/10.1001/jama.287.19.2519
  11. Real Collado JT, Valls M, Basanta Alario ML, et al. Factors associated with amputation in diabetic patients with foot ulcer. An Med Interna 2001;18:59-62.
  12. Resnick HE, Carter EA, Sosenko JM, et al. Incidence of lower- extremity amputation in American Indians: the Strong Heart Study. Diabetes Care 2004;27:1885-91. https://doi.org/10.2337/diacare.27.8.1885
  13. Hennis AJ, Fraser HS, Jonnalagadda R, et al. Explanations for the high risk of diabetes-related amputation in a Caribbean population of black african descent and potential for prevention. Diabetes Care 2004;27:2636-41. https://doi.org/10.2337/diacare.27.11.2636
  14. Margolis DJ, Hofstad O, Feldman HI. Association between renal failure and foot ulcer or lower-extremity amputation in patients with diabetes. Diabetes Care 2008;31:1331-6. https://doi.org/10.2337/dc07-2244
  15. Akha O, Kashi Z, Makhlough A. Correlation between amputation of diabetic foot and nephropathy. Iran J Kidney Dis 2010;4:27-31.
  16. Jeandrot A, Richard JL, Combescure C, et al. Serum procalcitonin and C-reactive protein concentrations to distinguish mildly infected from non-infected diabetic foot ulcers: a pilot study. Diabetologia 2008;51:347-52. https://doi.org/10.1007/s00125-007-0840-8
  17. Vanholder R, Ringoir S, Dhondt A, et al. Phagocytosis in uremic and hemodialysis patients: a prospective and cross sectional study. Kidney Int 1991;39:320-7. https://doi.org/10.1038/ki.1991.40
  18. Ringoir S, Schoots A, Vanholder R. Uremic toxins. Kidney Int Suppl 1988;24:S4-9.
  19. Chonchol M. Neutrophil dysfunction and infection risk in end-stage renal disease. Semin Dial 2006;19:291-6. https://doi.org/10.1111/j.1525-139X.2006.00175.x
  20. Young BA, Maynard C, Reiber G, et al. Effects of ethnicity and nephropathy on lower-extremity amputation risk among diabetic veterans. Diabetes Care 2003;26:495-501. https://doi.org/10.2337/diacare.26.2.495
  21. Speckman RA, Frankenfield DL, Roman SH, et al. Diabetes is the strongest risk factor for lower-extremity amputation in new hemodialysis patients. Diabetes Care 2004;27:2198-203. https://doi.org/10.2337/diacare.27.9.2198

Cited by

  1. Predictive factors for successful limb salvage surgery in diabetic foot patients vol.14, pp.None, 2014, https://doi.org/10.1186/1471-2482-14-113
  2. The feasibility study to establish the tailor-made nutritional therapy for patients with chronic limb wounds vol.6, pp.3, 2013, https://doi.org/10.7792/jlspm.6.161
  3. Comprehensive proteomic analysis of a Chinese 2‐herb formula (Astragali Radix and Rehmanniae Radix) on mature endothelial cells vol.14, pp.17, 2013, https://doi.org/10.1002/pmic.201300547
  4. Factors associated with diabetic foot amputations vol.14, pp.1, 2015, https://doi.org/10.1590/1677-5449.20140049
  5. High cystatin C levels predict undesirable outcome for diabetic foot ulcerations vol.24, pp.3, 2013, https://doi.org/10.1111/wrr.12419
  6. Is Angiosome-Targeted Angioplasty Effective for Limb Salvage and Wound Healing in Diabetic Foot? : A Meta-Analysis vol.11, pp.7, 2016, https://doi.org/10.1371/journal.pone.0159523
  7. Curative Metatarsal Bone Surgery Combined with Intralesional Administration of Recombinant Human Epidermal Growth Factor in Diabetic Neuropathic Ulceration of the Forefoot: A Prospective, Open, Uncont vol.85, pp.None, 2013, https://doi.org/10.1016/j.curtheres.2017.03.003
  8. Influence of Epidemiologic and Patient Behavior-Related Predictors on Amputation Rates in Diabetic Patients : Systematic Review and Meta-Analysis vol.16, pp.1, 2013, https://doi.org/10.1177/1534734617699318
  9. Factors Associated with a Prolonged Length of Hospital Stay in Patients with Diabetic Foot: A Single-Center Retrospective Study vol.44, pp.6, 2013, https://doi.org/10.5999/aps.2017.01207
  10. Diabetic foot ulcers-comparison of performance of ankle-brachial index and transcutaneous partial oxygen pressure in predicting outcome vol.38, pp.2, 2013, https://doi.org/10.1007/s13410-017-0580-3
  11. The appropriate management algorithm for diabetic foot: A single-center retrospective study over 12 years vol.97, pp.27, 2013, https://doi.org/10.1097/md.0000000000011454
  12. Polydeoxyribonucleotide-delivering therapeutic hydrogel for diabetic wound healing vol.10, pp.1, 2020, https://doi.org/10.1038/s41598-020-74004-0
  13. Silver Sulfadiazine Eradicates Antibiotic-Tolerant Staphylococcus aureus and Pseudomonas aeruginosa Biofilms in Patients with Infected Diabetic Foot Ulcers vol.9, pp.12, 2020, https://doi.org/10.3390/jcm9123807
  14. Non-vascular contributing factors of diabetic foot ulcer severity in national referral hospital of Indonesia vol.20, pp.1, 2013, https://doi.org/10.1007/s40200-021-00827-x
  15. Overcoming severe calcified lower extremity artery in lower limb salvage operation by using the Fogarty catheter and vein graft vol.41, pp.8, 2013, https://doi.org/10.1002/micr.30816
  16. Association between socioeconomic position and diabetic foot ulcer outcomes: a population-based cohort study in South Korea vol.21, pp.1, 2021, https://doi.org/10.1186/s12889-021-11406-3