BACKGROUND: Diabetic foot infections are associated with substantial morbidity and mortality. Prediction of diabetic foot ulcer outcome may be helpful for optimizing management strategy. This study aimed to determine the major predictors of amputation and length of stay in diabetic patients with acute foot ulceration. METHODS: A total of 55 type 2 diabetic patients with diabetic foot infection were enrolled. The patients were evaluated according to the Infectious Diseases Society of America and International Working Group on the Diabetic Foot criteria and also the Wagner's classification. Blood samples were taken at the start of hospitalization for the measurement of glucose, hemoglobin A1C (HbA1C), white blood cells (WBC), C-reactive protein (CRP), and erythrocyte sedimentation rate (ESR). Length of stay in hospital was recorded. RESULTS: WBC and CRP were significantly higher in lower-extremity amputation (LEA) group (p = 0.001 and p = 0.008, respectively); also, ESR was higher in this group, but there was no statistical significance. Wagner grade and infection severity were significantly higher in the LEA group as compared with the non-LEA group (both p values < 0.001). Glycemic control parameters (i.e., HbA1C, plasma glucose) were not different in LEA and non-LEA groups. In correlation analyses, amputation rate was negatively correlated (r = - 0.512, p < 0.001) with length of stay. WBC, ESR, CRP, Wagner grade, and severity of infection showed positive correlation with length of stay (r = 0.493, p < 0.001; r = 0.271, p = 0.045; r = 0.299, p = 0.027; r = 0.434, p = 0.001; and r = 0.464, p < 0.001, respectively). CONCLUSIONS: Baseline levels of acute-phase reactants, especially CRP, WBC, ESR, and increased Wagner grade, appeared to be helpful in predicting amputation and length of stay in diabetic patients with acute foot ulceration. However, duration of diabetes and glucose control seems to have no effect.
BACKGROUND:Diabetic foot infections are associated with substantial morbidity and mortality. Prediction of diabetic foot ulcer outcome may be helpful for optimizing management strategy. This study aimed to determine the major predictors of amputation and length of stay in diabeticpatients with acute foot ulceration. METHODS: A total of 55 type 2 diabeticpatients with diabetic foot infection were enrolled. The patients were evaluated according to the Infectious Diseases Society of America and International Working Group on the Diabetic Foot criteria and also the Wagner's classification. Blood samples were taken at the start of hospitalization for the measurement of glucose, hemoglobin A1C (HbA1C), white blood cells (WBC), C-reactive protein (CRP), and erythrocyte sedimentation rate (ESR). Length of stay in hospital was recorded. RESULTS: WBC and CRP were significantly higher in lower-extremity amputation (LEA) group (p = 0.001 and p = 0.008, respectively); also, ESR was higher in this group, but there was no statistical significance. Wagner grade and infection severity were significantly higher in the LEA group as compared with the non-LEA group (both p values < 0.001). Glycemic control parameters (i.e., HbA1C, plasma glucose) were not different in LEA and non-LEA groups. In correlation analyses, amputation rate was negatively correlated (r = - 0.512, p < 0.001) with length of stay. WBC, ESR, CRP, Wagner grade, and severity of infection showed positive correlation with length of stay (r = 0.493, p < 0.001; r = 0.271, p = 0.045; r = 0.299, p = 0.027; r = 0.434, p = 0.001; and r = 0.464, p < 0.001, respectively). CONCLUSIONS: Baseline levels of acute-phase reactants, especially CRP, WBC, ESR, and increased Wagner grade, appeared to be helpful in predicting amputation and length of stay in diabeticpatients with acute foot ulceration. However, duration of diabetes and glucose control seems to have no effect.
Authors: Kyrstin L Lane; Mohammed S Abusamaan; Betiel Fesseha Voss; Emilia G Thurber; Noora Al-Hajri; Shraddha Gopakumar; Jimmy T Le; Sharoon Gill; Jaime Blanck; Laura Prichett; Caitlin W Hicks; Ronald L Sherman; Christopher J Abularrage; Nestoras N Mathioudakis Journal: J Diabetes Complications Date: 2020-05-22 Impact factor: 2.852
Authors: Betiel K Fesseha; Christopher J Abularrage; Kathryn F Hines; Ronald Sherman; Priscilla Frost; Susan Langan; Joseph Canner; Kendall C Likes; Sayed M Hosseini; Gwendolyne Jack; Caitlin W Hicks; Swaytha Yalamanchi; Nestoras Mathioudakis Journal: Diabetes Care Date: 2018-04-16 Impact factor: 19.112
Authors: Irvin Oh; Gowrishankar Muthukrishnan; Mark J Ninomiya; James D Brodell; Benjamin L Smith; Charles C Lee; Steven R Gill; Christopher A Beck; Edward M Schwarz; John L Daiss Journal: Infect Immun Date: 2018-11-20 Impact factor: 3.441
Authors: Stephanie P Hao; Elysia A Masters; Mark J Ninomiya; Christopher A Beck; Edward M Schwarz; John L Daiss; Irvin Oh Journal: Foot Ankle Int Date: 2020-11-09 Impact factor: 2.827
Authors: Aron Sulovari; Mark J Ninomiya; Christopher A Beck; Benjamin F Ricciardi; Constantinos Ketonis; Addisu Mesfin; Nathan B Kaplan; Sandeep P Soin; Susan M McDowell; Bilal Mahmood; John L Daiss; Edward M Schwarz; Irvin Oh Journal: J Orthop Res Date: 2020-12-15 Impact factor: 3.102