Diabetic foot score: a predictive model for leg amputation in patients with diabetic foot disease
DOI:
https://doi.org/10.13181/mji.oa.247427Keywords:
amputation, diabetic foot, leg, risk factorsAbstract
BACKGROUND Patients with diabetes mellitus are at a higher risk for peripheral artery disease (PAD) and diabetic foot disease (DFD), which can ultimately result in leg amputation. This study aimed to develop a novel scoring system to predict the risk of leg amputation using widely available modalities, including demographic characteristics and various laboratory data.
METHODS This study was conducted at Dr. Soetomo General Hospital and analyzed risk factors for leg amputation in 99 patients with DFD who underwent leg amputation compared with 80 control patients. This study presented a predictive model for leg amputation in patients with DFD, using odds ratio (OR) analysis and logistic regression approach with confidence intervals (CIs) set at 95%. The data analysis was conducted using SPSS software version 25.0.
RESULTS PAD (OR 6.52, 95% CI = 2.19–19.37, p = 0.001), high low-density lipoprotein cholesterol (OR 5.97, 95% CI = 2.31–15.43, p<0.001), type of DFD (OR 4.58, 95% CI = 2.14–9.79, p<0.001), poor glycemic control (OR 4.48, 95% CI = 1.78–11.28, p = 0.001), and neutrophil-to-lymphocyte ratio level (OR 1.04, 95% CI = 1.00–1.07, p = 0.025) were the independent predictors for leg amputation. The predictive model, developed using multivariate analysis with an area under the curve of 89%, optimum threshold of 0.5 (score 6), sensitivity of 84.8%, and specificity of 78.8%, indicating a promising approach for predicting leg amputation outcomes.
CONCLUSIONS The newly developed diabetic foot score may assist in making decisions regarding therapeutic options for patients with DFD.
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References
Schmidt AM. Highlighting diabetes mellitus: the epidemic continues. Arterioscler Thromb Vasc Biol. 2018;38(1):e1-8. https://doi.org/10.1161/ATVBAHA.117.310221
Lavery LA, Oz OK, Bhavan K, Wukich DK. Diabetic foot syndrome in the twenty-first century. Clin Podiatr Med Surg. 2019;36(3):355-9. https://doi.org/10.1016/j.cpm.2019.02.002
Lin CW, Armstrong DG, Lin CH, Liu PH, Hung SY, Lee SR, et al. Nationwide trends in the epidemiology of diabetic foot complications and lower-extremity amputation over an 8-year period. BMJ Open Diabetes Res Care. 2019;7(1):e000795. https://doi.org/10.1136/bmjdrc-2019-000795
Font-Jiménez I, Llaurado-Serra M, Roig-Garcia M, De Los Mozos-Perez B, Acebedo-Urdiales S. Retrospective study of the evolution of the incidence of non-traumatic lower-extremity amputations (2007-2013) and risk factors of reamputation. Prim Care Diabetes. 2016;10(6):434-41. https://doi.org/10.1016/j.pcd.2016.04.001
Peng B, Min R, Liao Y, Yu A. Development of predictive nomograms for clinical use to quantify the risk of amputation in patients with diabetic foot ulcer. J Diabetes Res. 2021;2021:6621035. https://doi.org/10.1155/2021/6621035
Hoffstad O, Mitra N, Walsh J, Margolis DJ. Diabetes, lower-extremity amputation, and death. Diabetes Care. 2015;38(10):1852-7. https://doi.org/10.2337/dc15-0536
Ugwu E, Adeleye O, Gezawa I, Okpe I, Enamino M, Ezeani I. Predictors of lower extremity amputation in patients with diabetic foot ulcer: findings from MEDFUN, a multi-center observational study. J Foot Ankle Res. 2019;12:34. https://doi.org/10.1186/s13047-019-0345-y
Thorud JC, Plemmons B, Buckley CJ, Shibuya N, Jupiter DC. Mortality After nontraumatic major amputation among patients with diabetes and peripheral vascular disease: a systematic review. J Foot Ankle Surg. 2016;55(3):591-9. https://doi.org/10.1053/j.jfas.2016.01.012
Peter-Riesch B. The diabetic foot: the never-ending challenge: contemporary options of screening, management and prevention of foot pathologies in diabetic patients. In: Stettler C, Christ E, Diem P, editors. Novelties in diabetes [Internet]. Basel: S. Karger AG; 2016. Available from: https://doi.org/10.1159/000439409. https://doi.org/10.1159/000439409
Soelistijo SA, Suastika K, Lindarto D, Decroli E, Permana H, Sucipto KW, et al. [Guidelines for the management and prevention of type 2 diabetes mellitus in adults in Indonesia]. PB Perkeni; 2021. Indonesian.
Thamrin H, Sutjahjo A, Pranoto A, Soelistijo S. Association of metabolic syndrome with albuminuria in diabetes mellitus type 2. Biomolecular and Health Science Journal. 2019;2(2):82-8. https://doi.org/10.20473/bhsj.v2i2.14964
Shojaiefard A, Khorgami Z, Larijani B. Independent risk factors for amputation in diabetic foot. Int J Diabetes Dev Ctries. 2008;28(2):32-7. https://doi.org/10.4103/0973-3930.43096
Laclé A, Valero-Juan LF. Diabetes-related lower-extremity amputation incidence and risk factors: a prospective seven-year study in Costa Rica. Rev Panam Salud Publica. 2012;32(3):192-8. https://doi.org/10.1590/S1020-49892012000900004
Yu Q, Wong GY, Osborne MP, Hsu Y, Ai X. The Lehmann model with time-dependent covariates. Commun Stat - Theor M. 2015;44(20):4380-95. https://doi.org/10.1080/03610926.2013.784991
Pemayun TG, Naibaho RM, Novitasari D, Amin N, Minuljo TT. Risk factors for lower extremity amputation in patients with diabetic foot ulcers: a hospital-based case-control study. Diabet Foot Ankle. 2015;6:29629. https://doi.org/10.3402/dfa.v6.29629
Martins-Mendes D, Monteiro-Soares M, Boyko EJ, Ribeiro M, Barata P, Lima J, et al. The independent contribution of diabetic foot ulcer on lower extremity amputation and mortality risk. J Diabetes Complications. 2014;28(5):632-8. https://doi.org/10.1016/j.jdiacomp.2014.04.011
Soewondo P, Soegondo S, Suastika K, Pranoto A, Soeatmadji DW. The DiabCare Asia 2008 study - outcomes on control and complications of type 2 diabetic patients in Indonesia. Med J Indones. 2010;19(4):235-44. https://doi.org/10.13181/mji.v19i4.412
Resnick HE, Carter EA, Sosenko JM, Henly SJ, Fabsitz RR, Ness FK, et al. Incidence of lower-extremity amputation in American Indians: the Strong Heart Study. Diabetes Care. 2004;27(8):1885-91. https://doi.org/10.2337/diacare.27.8.1885
Miyajima S, Shirai A, Yamamoto S, Okada N, Matsushita T. Risk factors for major limb amputations in diabetic foot gangrene patients. Diabetes Res Clin Pract. 2006;71(3):272-9. https://doi.org/10.1016/j.diabres.2005.07.005
Prompers L, Schaper N, Apelqvist J, Edmonds M, Jude E, Mauricio D, et al. Prediction of outcome in individuals with diabetic foot ulcers: focus on the differences between individuals with and without peripheral arterial disease. The EURODIALE Study. Diabetologia. 2008;51(5):747-55. https://doi.org/10.1007/s00125-008-0940-0
Reiber GE, Pecoraro RE, Koepsell TD. Risk factors for amputation in patients with diabetes mellitus. A case-control study. Ann Intern Med. 1992;117(2):97-105. https://doi.org/10.7326/0003-4819-117-2-97
Calle-Pascual AL, Garcia-Torre N, Moraga I, Diaz JA, Duran A, Moñux G, et al. Epidemiology of nontraumatic lower-extremity amputation in area 7, Madrid, between 1989 and 1999: a population-based study. Diabetes Care. 2001;24(9):1686-9. https://doi.org/10.2337/diacare.24.9.1686
Imran S, Ali R, Mahboob G. Frequency of lower extremity amputation in diabetics with reference to glycemic control and Wagner's grades. J Coll Physicians Surg Pak. 2006;16(2):124-7.
Stratton IM, Adler AI, Neil HA, Matthews DR, Manley SE, Cull CA, et al. Association of glycaemia with macrovascular and microvascular complications of type 2 diabetes (UKPDS 35): prospective observational study. BMJ. 2000;321(7258):405-12. https://doi.org/10.1136/bmj.321.7258.405
Gaede P, Lund-Andersen H, Parving HH, Pedersen O. Effect of a multifactorial intervention on mortality in type 2 diabetes. N Engl J Med. 2008;358(6):580-91. https://doi.org/10.1056/NEJMoa0706245
Adler AI, Erqou S, Lima TA, Robinson AH. Association between glycated haemoglobin and the risk of lower extremity amputation in patients with diabetes mellitus-review and meta-analysis. Diabetologia. 2010;53(5):840-9. https://doi.org/10.1007/s00125-009-1638-7
Jolissaint JS, Shah SK, Martin MC, Raffetto JD, McPhee JT. Risk prediction of 30-day mortality after lower extremity major amputation. J Vasc Surg. 2019;70(6):1868-76. https://doi.org/10.1016/j.jvs.2019.03.036
Zubair M, Malik A, Ahmad J. Incidence, risk factors for amputation among patients with diabetic foot ulcer in a North Indian tertiary care hospital. Foot (Edinb). 2012;22(1):24-30. https://doi.org/10.1016/j.foot.2011.09.003
Novida H, Soelistyo SA, Cahyani C, Siagian N, Hadi U, Pranoto A. Factors associated with disease severity of COVID-19 in patients with type 2 diabetes mellitus. Biomed Rep. 2022;18(1):8. https://doi.org/10.3892/br.2022.1590
Lu Q, Wang J, Wei X, Wang G, Xu Y. Risk factors for major amputation in diabetic foot ulcer patients. Diabetes Metab Syndr Obes. 2021;14:2019-27. https://doi.org/10.2147/DMSO.S307815
Nishijima A, Yamamoto N, Yoshida R, Hozawa K, Yanagibayashi S, Takikawa M, et al. Coronary artery disease in patients with critical limb ischemia undergoing major amputation or not. Plast Reconstr Surg Glob Open. 2017;5(6):e1377. https://doi.org/10.1097/GOX.0000000000001377
Shareef AM, Ahmedani MY, Waris N. Strong association of anemia in people with diabetic foot ulcers (DFUs): Study from a specialist foot care center. Pak J Med Sci. 2019;35(5):1216-20. https://doi.org/10.12669/pjms.35.5.1421
Mansoor Z, Modaweb A. Predicting amputation in patients with diabetic foot ulcers: a systematic review. Cureus. 2022;14(7):e27245. https://doi.org/10.7759/cureus.27245
Chou YY, Hou CC, Wu CW, Huang DW, Tsai SL, Liu TH, et al. Risk factors that predict major amputations and amputation time intervals for hospitalised diabetic patients with foot complications. Int Wound J. 2022;19(6):1329-38. https://doi.org/10.1111/iwj.13727
Aziz Z, Lin WK, Nather A, Huak CY. Predictive factors for lower extremity amputations in diabetic foot infections. Diabet Foot Ankle. 2011;2. https://doi.org/10.3402/dfa.v2i0.7463
Yesil S, Akinci B, Yener S, Bayraktar F, Karabay O, Havitcioglu H, Yet al. Predictors of amputation in diabetics with foot ulcer: single center experience in a large Turkish cohort. Hormones (Athens). 2009;8(4):286-95. https://doi.org/10.14310/horm.2002.1245
Marcovecchio ML, Lucantoni M, Chiarelli F. Role of chronic and acute hyperglycemia in the development of diabetes complications. Diabetes Technol Ther. 2011;13(3):38994. https://doi.org/10.1089/dia.2010.0146
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