Long term outcomes after incident diabetic foot ulcer: Multicenter large cohort prospective study (EDI-FOCUS investigators) epidemiology of diabetic foot complications study Epidemiology of diabetic foot complications study

被引:80
|
作者
Rastogi, Ashu [1 ]
Goyal, Ghanshyam [2 ,7 ]
Kesavan, Rajesh [3 ]
Bal, Arun [4 ]
Kumar, Harish [4 ]
Mangalanadanam [4 ]
Kamath, Priyatham [4 ]
Jude, Edward B. [5 ]
Armstrong, David G. [6 ]
Bhansali, Anil [1 ]
机构
[1] PGIMER, Dept Endocrinol, Room 1011,Nehru Hosp Extens Block, Chandigarh 160012, India
[2] ILS Hosp, Kolkata, India
[3] Hycare Wounds, Chennai, Tamil Nadu, India
[4] Amrita Inst Med Sci, Dept Endocrinol, Kochi, Kerala, India
[5] NHS Fdn & Trust, Tameside Hosp, Manchester, Lancs, England
[6] Univ Southern Calif, Keck Sch Med, Los Angeles, CA 90007 USA
[7] SVS Marwari Hosp, Amhesrst St, Kolkata, India
关键词
Diabetic foot ulcer; Mortality rate; Limb amputation; Neuropathy; Kaplan Meir survival; MORTALITY; AMPUTATION; DISEASE; RISK; SURVIVAL; IMPACT;
D O I
10.1016/j.diabres.2020.108113
中图分类号
R5 [内科学];
学科分类号
1002 ; 100201 ;
摘要
Aims: This long-term prospective study evaluated limb amputation and mortality after the first neuropathic diabetic foot ulcer (DFU). Methods: A total of 2880 patients with neuropathic DFU (DFU group) and a similar number of patients of diabetes without DFU (nDFU) matched for age and diabetes duration were prospectively assessed at five referral-centers over 14 years. Pre-defined outcome was death during follow-up. Various diabetic co-morbidities and amputation were assessed as mortality predictors. Results: Overall, 501 (17.4%) patients in DFU group died compared to 89 (3.1%) (p < 0.01) in nDFU group during a median follow-up of 7(1-14) years. The 5- and 10-year mortality was 22% and 71% in the DFU group with a median survival of 7.72 (7.37-8.08) years compared to 3% (p < 0.01) and 5% (p < 0.01) and survival of 12.6 (10.5-12.7) years (p < 0.001) in nDFU group. 29.3% patients had limb amputations. The mortality risk was independent of glycemic control [OR 1.03 (0.80-1.32; p = 0.83)]. However, diabetes duration > 10 years [OR 1.31(1.02-1.70, p = 0.035)], nephropathy [OR 1.47 (1.04-2.09, p < 0.030)], minor 1.85 (1.40-2.44; p < 0.001) or major amputation 2.96 (2.01-4.34, p < 0.001)] predicted mortality. Conclusions: Every one-in-three individual with neuropathic DFU has amputation and every sixth individual has an early demise. Prevalent nephropathy and incident amputation following DFU predicts mortality. (C) 2020 Elsevier B.V. All rights reserved.
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页数:8
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