Daniela Martins-Mendes1, Matilde Monteiro-Soares2, Edward John Boyko3, Manuela Ribeiro4, Pedro Barata5, Jorge Lima6, Raquel Soares7. 1. Diabetic Foot Clinic, Endocrinology, Diabetes and Metabolism Department - Centro Hospitalar de Vila Nova de Gaia/Espinho EPE, Vila Nova de Gaia, Portugal; Internal Medicine Department - Centro Hospitalar de Vila Nova de Gaia/Espinho EPE, Vila Nova de Gaia, Portugal; Biochemistry Department (U38-FCT)-Faculty of Medicine of the University of Porto, Oporto, Portugal. Electronic address: daniela.m.m.mendes@gmail.com. 2. CIDES/CINTESIS (U753-FCT)-Health Information and Decision Sciences Department, Oporto Faculty of Medicine, Oporto, Portugal. 3. Seattle Epidemiologic Research and Information Centre-Department of Veterans Affairs Puget Sound Health Care System and the University of Washington, Seattle, WA, USA. 4. Diabetic Foot Clinic, Endocrinology, Diabetes and Metabolism Department - Centro Hospitalar de Vila Nova de Gaia/Espinho EPE, Vila Nova de Gaia, Portugal. 5. Health Sciences Faculty of the Fernando Pessoa's University, Oporto, Portugal. 6. Cancer Biology Group-Institute of Molecular Pathology and Immunology of the University of Porto, Oporto, Portugal, Faculty of Medicine of the University of Porto, Oporto, Portugal. 7. Biochemistry Department (U38-FCT)-Faculty of Medicine of the University of Porto, Oporto, Portugal.
Abstract
AIMS: To estimate 3-year risk for diabetic foot ulcer (DFU), lower extremity amputation (LEA) and death; determine predictive variables and assess derived models accuracy. MATERIAL AND METHODS: Retrospective cohort study including all subjects with diabetes enrolled in our diabetic foot outpatient clinic from beginning 2002 until middle 2010. Data were collected from clinical records. RESULTS: 644 subjects with mean age of 65.1 (±11.2) and diabetes duration of 16.1 (±10.8) years. Cumulative incidence was 26.6% for DFU, 5.8% for LEA and 14.0% for death. In multivariate analysis, physical impairment, peripheral arterial disease complication history, complication count and previous DFU were associated with DFU; complication count, foot pulses and previous DFU with LEA and age, complication count and previous DFU with death. Predictive models' areas under the ROC curves ranged from 0.80 to 0.83. A simplified model including previous DFU and complication count presented high accuracy. Previous DFU was associated with all outcomes, even when adjusted for complication count, in addition to more complex models. CONCLUSIONS: DFU seems more than a marker of complication status, having independent impact on LEA and mortality risk. Proposed models may be applicable in healthcare settings to identify patients at higher risk of DFU, LEA and death.
AIMS: To estimate 3-year risk for diabetic foot ulcer (DFU), lower extremity amputation (LEA) and death; determine predictive variables and assess derived models accuracy. MATERIAL AND METHODS: Retrospective cohort study including all subjects with diabetes enrolled in our diabetic footoutpatient clinic from beginning 2002 until middle 2010. Data were collected from clinical records. RESULTS: 644 subjects with mean age of 65.1 (±11.2) and diabetes duration of 16.1 (±10.8) years. Cumulative incidence was 26.6% for DFU, 5.8% for LEA and 14.0% for death. In multivariate analysis, physical impairment, peripheral arterial disease complication history, complication count and previous DFU were associated with DFU; complication count, foot pulses and previous DFU with LEA and age, complication count and previous DFU with death. Predictive models' areas under the ROC curves ranged from 0.80 to 0.83. A simplified model including previous DFU and complication count presented high accuracy. Previous DFU was associated with all outcomes, even when adjusted for complication count, in addition to more complex models. CONCLUSIONS: DFU seems more than a marker of complication status, having independent impact on LEA and mortality risk. Proposed models may be applicable in healthcare settings to identify patients at higher risk of DFU, LEA and death.
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