The Korean journal of internal medicine

  • 제33권5호
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  • Pages.952-960
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  • 2018
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  • 1226-3303(pISSN)
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  • 2005-6648(eISSN)
대한내과학회 (The Korean Association of Internal Medicine)
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Depth and combined infection is important predictor of lower extremity amputations in hospitalized diabetic foot ulcer patients

  • Jeong, Eun-Gyo (Division of Endocrinology and Metabolism, Department of Internal Medicine, St. Vincent's Hospital, The Catholic University of Korea) ;
  • Cho, Sung Shim (Division of Endocrinology and Metabolism, Department of Internal Medicine, St. Vincent's Hospital, The Catholic University of Korea) ;
  • Lee, Sang-Hoon (Division of Endocrinology and Metabolism, Department of Internal Medicine, St. Vincent's Hospital, The Catholic University of Korea) ;
  • Lee, Kang-Min (Division of Endocrinology and Metabolism, Department of Internal Medicine, St. Vincent's Hospital, The Catholic University of Korea) ;
  • Woo, Seo-Kyung (Division of Endocrinology and Metabolism, Department of Internal Medicine, St. Vincent's Hospital, The Catholic University of Korea) ;
  • Kang, Yoongoo (Division of Endocrinology and Metabolism, Department of Internal Medicine, St. Vincent's Hospital, The Catholic University of Korea) ;
  • Yun, Jae-Seung (Division of Endocrinology and Metabolism, Department of Internal Medicine, St. Vincent's Hospital, The Catholic University of Korea) ;
  • Cha, Seon-Ah (Division of Endocrinology and Metabolism, Department of Internal Medicine, St. Vincent's Hospital, The Catholic University of Korea) ;
  • Kim, Yoon-Jung (Department of Orthopedic Surgery, College of Medicine, St. Vincent's Hospital, The Catholic University of Korea) ;
  • Ahn, Yu-Bae (Division of Endocrinology and Metabolism, Department of Internal Medicine, St. Vincent's Hospital, The Catholic University of Korea) ;
  • Ko, Seung-Hyun (Division of Endocrinology and Metabolism, Department of Internal Medicine, St. Vincent's Hospital, The Catholic University of Korea) ;
  • Lee, Jung-Min (Division of Endocrinology and Metabolism, Department of Internal Medicine, College of Medicine, St. Paul's Hospital, The Catholic University of Korea)
  • 투고 : 2016.05.23
  • 심사 : 2016.10.06
  • 발행 : 2018.09.01
⟨ 이전 논문 다음 논문 ⟩

초록

Background/Aims: As the prevalence of diabetes mellitus and its complications increase rapidly, diabetic foot ulcers (DFUs), which are a major diabetic complication, are expected to increase. For prevention and effective treatment, it is important to understand the clinical course of DFUs. The aim of this study was to investigate the natural course and predictors of amputation in patients with DFUs who required hospitalization Methods: A total of 209 patients with type 2 diabetes, aged 30 to 85 years, who visited emergency department or needed hospitalization due to DFUs were consecutively enrolled from May 2012 to January 2016, by retrospective medical record review. The main outcome was lower extremity amputation (LEA). Results: Among 192 patients who completed follow-up, 113 patients (58.9%) required LEAs. Compared to patients without amputation, baseline levels of white blood cell counts and C-reactive protein were higher in patients with amputation. In addition, bone and joint involvement was more frequently observed in patients with amputation. Multivariable regression analysis revealed that combined infection (odds ratio [OR], 11.39; 95% confidence interval [CI], 2.55 to 50.93; p = 0.001) and bone or joint involvement (OR, 3.74; 95% CI, 1.10 to 12.70; p = 0.035) were significantly associated with an increased risk of LEA. Conclusions: The depth of the wound and combined infection of DFU, rather than the extent of the wound, were significant prognostic factors of LEAs in patients with type 2 diabetes.

키워드

참고문헌

  1. Centers for Disease Control and Prevention. National diabetes statistics report: estimates of diabetes and its burden in the United States, 2014 [Internet]. Atlanta (GA): U.S. Department of Health and Human Services, 2014 [cited 2017 Feb 16]. Available from: http://www.cdc.gov/diabetes.
  2. Woodbury MG. Diabetic foot risk assessment. Diabetes Metab Res Rev 2016;32:376-378. https://doi.org/10.1002/dmrr.2784
  3. International Diabetes Federation. IDF Diabetes Atlas, 7th ed [Internet]. Brussels (BE): International Diabetes Federation, 2015 [cited 2017 Feb 16]. Available from: http://www.diabetesatlas.org.
  4. Centers for Disease Control and Prevention. National health and nutrition examination survey, 2014 [Internet]. Cheongju (KR): National Health and Nutrition Examination Survey, 2014 [cited 2017 Feb 16]. Available from: https://knhanes.cdc.go.kr.
  5. Amin N, Doupis J. Diabetic foot disease: from the evaluation of the “foot at risk” to the novel diabetic ulcer treatment modalities. World J Diabetes 2016;7:153-164. https://doi.org/10.4239/wjd.v7.i7.153
  6. Task Force Team for Basic Statistical Study of Korean Diabetes Mellitus of Korean Diabetes Association, Park IeB, Kim J, et al. Diabetes epidemics in Korea: reappraise nationwide survey of diabetes "diabetes in Korea 2007". Diabetes Metab J 2013;37:233-239. https://doi.org/10.4093/dmj.2013.37.4.233
  7. Madanchi N, Tabatabaei-Malazy O, Pajouhi M, Heshmat R, Larijani B, Mohajeri-Tehrani MR. Who are diabetic foot patients? A descriptive study on 873 patients. J Diabetes Metab Disord 2013;12:36. https://doi.org/10.1186/2251-6581-12-36
  8. Hicks CW, Selvarajah S, Mathioudakis N, et al. Burden of infected diabetic foot ulcers on hospital admissions and costs. Ann Vasc Surg 2016;33:149-158. https://doi.org/10.1016/j.avsg.2015.11.025
  9. Chung CH, Kim DJ, Kim J, et al. Current status of diabetic foot in Korean patients using national health insurance database. J Korean Diabetes Assoc 2006;30:372-376. https://doi.org/10.4093/jkda.2006.30.5.372
  10. Levey AS, Bosch JP, Lewis JB, Greene T, Rogers N, Roth D. A more accurate method to estimate glomerular filtration rate from serum creatinine: a new prediction equation. Modification of Diet in Renal Disease Study Group. Ann Intern Med 1999;130:461-470. https://doi.org/10.7326/0003-4819-130-6-199903160-00002
  11. Yun JS, Ko SH, Ko SH, et al. Cardiovascular disease predicts severe hypoglycemia in patients with type 2 diabetes. Diabetes Metab J 2015;39:498-506. https://doi.org/10.4093/dmj.2015.39.6.498
  12. Bravo-Molina A, Linares-Palomino JP, Lozano-Alonso S, Asensio-Garcia R, Ros-Die E, Hernandez-Quero J. Influence of wound scores and microbiology on the outcome of the diabetic foot syndrome. J Diabetes Complications 2016;30:329-334. https://doi.org/10.1016/j.jdiacomp.2015.11.001
  13. Gregg EW, Li Y, Wang J, et al. Changes in diabetes-related complications in the United States, 1990-2010. N Engl J Med 2014;370:1514-1523. https://doi.org/10.1056/NEJMoa1310799
  14. Ahmad J. The diabetic foot. Diabetes Metab Syndr 2016;10:48-60. https://doi.org/10.1016/j.dsx.2015.04.002
  15. Tomita M, Kabeya Y, Okisugi M, et al. Diabetic microangiopathy is an independent predictor of incident diabetic foot ulcer. J Diabetes Res 2016;2016:5938540.
  16. Bruun C, Siersma V, Guassora AD, Holstein P, de Fine Olivarius N. Amputations and foot ulcers in patients newly diagnosed with type 2 diabetes mellitus and observed for 19 years: the role of age, gender and co-morbidity. Diabet Med 2013;30:964-972. https://doi.org/10.1111/dme.12196
  17. Parisi MC, Moura Neto A, Menezes FH, et al. Baseline characteristics and risk factors for ulcer, amputation and severe neuropathy in diabetic foot at risk: the BRAZUPA study. Diabetol Metab Syndr 2016;8:25. https://doi.org/10.1186/s13098-016-0126-8
  18. Singh N, Armstrong DG, Lipsky BA. Preventing foot ulcers in patients with diabetes. JAMA 2005;293:217-228. https://doi.org/10.1001/jama.293.2.217
  19. Hsu CR, Chang CC, Chen YT, Lin WN, Chen MY. Organization of wound healing services: the impact on lowering the diabetes foot amputation rate in a ten-year review and the importance of early debridement. Diabetes Res Clin Pract 2015;109:77-84. https://doi.org/10.1016/j.diabres.2015.04.026
  20. Noor S, Zubair M, Ahmad J. Diabetic foot ulcer: a review on pathophysiology, classification and microbial etiology. Diabetes Metab Syndr 2015;9:192-199. https://doi.org/10.1016/j.dsx.2015.04.007
  21. Uckay I, Aragon-Sanchez J, Lew D, Lipsky BA. Diabetic foot infections: what have we learned in the last 30 years? Int J Infect Dis 2015;40:81-91. https://doi.org/10.1016/j.ijid.2015.09.023
  22. Beaney AJ, Nunney I, Gooday C, Dhatariya K. Factors determining the risk of diabetes foot amputations: a retrospective analysis of a tertiary diabetes foot care service. Diabetes Res Clin Pract 2016;114:69-74. https://doi.org/10.1016/j.diabres.2016.02.001
  23. Quilici MT, Del Fiol Fde S, Vieira AE, Toledo MI. Risk factors for foot amputation in patients hospitalized for diabetic foot infection. J Diabetes Res 2016;2016:8931508.

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  2. Risk factors for lower extremity amputation in patients with diabetic foot ulcers: A meta-analysis vol.15, pp.9, 2018, https://doi.org/10.1371/journal.pone.0239236
  3. Hyperbaric oxygen treatment for University of Texas grade 3 diabetic foot ulcers: a retrospective cohort study vol.30, pp.9, 2018, https://doi.org/10.12968/jowc.2021.30.9.722
  4. Biomechanical modelling of diabetic foot ulcers: A computational study vol.127, pp.None, 2018, https://doi.org/10.1016/j.jbiomech.2021.110699