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. 2021 May 4:14:2019-2027.
doi: 10.2147/DMSO.S307815. eCollection 2021.

Risk Factors for Major Amputation in Diabetic Foot Ulcer Patients

Qingwei Lu  1 , Jun Wang  1 , Xiaolu Wei  2 , Gang Wang  1 , Yang Xu  1
Affiliations

Risk Factors for Major Amputation in Diabetic Foot Ulcer Patients

Qingwei Lu et al. Diabetes Metab Syndr Obes. .

Abstract

Background: The purpose of our study was to identify the new and the more specific risk factors for major amputation in patients with diabetic foot ulcer (DFU).

Methods: We used data from the Electronic Medical Record (EMR) database of our hospital from February 2014 to July 2020. Patients with DFU and amputation were included in the study. The logistic regression model was adjusted for demographic characteristics and related comorbidities between major and minor amputation groups.

Results: Among 3654 patients with DFU, 363 (9.9%) were amputated. Patients with major versus minor amputation, in multivariable logistic regression models, major amputation independent factors included previous amputation history (odds ratio [OR] 2.31 [95% CI 1.17-4.53], p = 0.02), smoking (2.58 [1.31-5.07], p = 0.01), coronary artery disease (CAD) (2.67 [1.35-5.29], p = 0.03), ankle brachial index (ABI) <0.4 (15.77 [7.51-33.13], p < 0.01), Wagner 5 (5.50 [1.89-16.01], p < 0.01), activated partial thromboplastin time (APTT) (1.23 [1.03-1.48], p = 0.01), glycosylated hemoglobin A1c (HbA1c) (1.23 [1.03-1.48], p = 0.03), hemoglobin (Hb) (0.98 [0.96-1.00], p = 0.01), plasma albumin (ALB) (0.88 [0.81-0.95], p < 0.01) and white blood cell (WBC) (1.10 [1.04-1.16], p < 0.01).

Conclusion: Major amputation was associated with previous amputation history, smoking, CAD, Wagner 5, ABI <0.4, HbA1c, Hb, ALB, WBC, and APTT might be a new independent factor. In view of these factors, early prevention and guidance promptly orientated by multidisciplinary is of great significance to reduce the disability rate and economic burden.

Keywords: diabetic foot ulcers; major amputation; minor amputation; retrospective analysis; risk factors.

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Conflict of interest statement

The authors declare no conflicts of interest in this work.

Figures

Figure 1
Figure 1
Selection flow diagram.
Figure 2
Figure 2
Independent risk factors for major amputation. (A) categorical variable (amputation history, smoking, CAD, ABI<0.4, Wagner 5); (B) continuous variables (APTT, HbA1c, Hb, ALB, WBC).
See this image and copyright information in PMC

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Grants and funding

This study was funded by the National Natural Science Foundation of China (81973854, 81473685) and Ministry of Science and Technology of China (2008BAI53B01, 2008BAI53B011).

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