Montserrat Doria1, Jordi Viadé2, Elisabet Palomera3, Ricard Pérez4, Melcior Lladó5, Elisabet Costa6, Teresa Huguet7, Jordi Lluís Reverter2, Mateu Serra-Prat3, Josep Franch-Nadal8, Dídac Mauricio9. 1. Department of Endocrinology and Nutrition, University Hospital & Health Sciences Research Institute Germans Trias i Pujol, Badalona, Spain; Diabetic Foot Unit, University Hospital Arnau de Vilanova, Lleida, Spain. 2. Department of Endocrinology and Nutrition, University Hospital & Health Sciences Research Institute Germans Trias i Pujol, Badalona, Spain. 3. Epidemiology Service, Hospital de Mataró, Mataró, Spain. 4. Department of Radiology, University Hospital Germans Trias i Pujol, Badalona, Spain. 5. Diabetic Foot Unit, University Hospital Son Espases, Palma de Mallorca, Spain. 6. Department of Endocrinology and Nutrition, University Hospital Josep Trueta, Girona, Spain. 7. Diabetic Foot Unit, University Hospital Mutua, Terrassa, Spain. 8. Unitat de Suport a la Recerca Barcelona Ciutat, Institut Universitari d'Investigació en Atenció Primària Jordi Gol (IDIAP Jordi Gol), Barcelona, Spain; CIBER of Diabetes and Associated Metabolic Diseases (CIBERDEM), Instituto de Salud Carlos III, Spain; Primary Health Care Center Raval Sud, Gerència d'Atenció Primaria, Institut Català de la Salut, Barcelona, Spain. 9. Department of Endocrinology and Nutrition, University Hospital & Health Sciences Research Institute Germans Trias i Pujol, Badalona, Spain; Unitat de Suport a la Recerca Barcelona Ciutat, Institut Universitari d'Investigació en Atenció Primària Jordi Gol (IDIAP Jordi Gol), Barcelona, Spain; CIBER of Diabetes and Associated Metabolic Diseases (CIBERDEM), Instituto de Salud Carlos III, Spain; Department of Endocrinology & Nutrition, Hospital de la Santa Creu i Sant Pau, Autonomous University of Barcelona, Barcelona, Spain. Electronic address: didacmauricio@gmail.com.
Abstract
OBJECTIVES: To assess the clinical characteristics of patients with Charcot neuroarthropathy (CN) in Spain and to identify predictors for CN-related complications. PATIENTS AND METHODS: A retrospective study was conducted at five tertiary hospitals with diabetic foot care units in Spain. Data were collected from 83 patients, including demographic profiles, foot factors, diabetes characteristics, and presence of microvascular and macrovascular comorbidity, and a podiatric examination was also performed. Logistic regression analyses were used to determine significant predictors of the predefined clinical events. RESULTS: Signs of diabetic neuropathy were found in almost all patients (98.9%) at the initial assessment, approximately half of them had diabetic retinopathy or nephropathy (61.5% and 51.8%, respectively), and peripheral artery disease was uncommon (8.6%). Thirty-eight patients (47.5%) experienced one or more relevant clinical events: 22 (27.5%) a new foot ulcer; 7 (8.7%) a major amputation; 20 (25%) were admitted to hospital; and 4 (5%) died. Only the presence of diabetic nephropathy was independently associated to development of any of the complications studied (p = 0.009; odds ratio = 3.37; 95% CI: 1.12-10.1). CONCLUSIONS: Almost half the patients with CN attending specialised foot care units in tertiary hospitals experienced short-term CN-associated complications, and the risk was 3 times higher in those with a history of diabetic nephropathy.
OBJECTIVES: To assess the clinical characteristics of patients with Charcot neuroarthropathy (CN) in Spain and to identify predictors for CN-related complications. PATIENTS AND METHODS: A retrospective study was conducted at five tertiary hospitals with diabetic foot care units in Spain. Data were collected from 83 patients, including demographic profiles, foot factors, diabetes characteristics, and presence of microvascular and macrovascular comorbidity, and a podiatric examination was also performed. Logistic regression analyses were used to determine significant predictors of the predefined clinical events. RESULTS: Signs of diabetic neuropathy were found in almost all patients (98.9%) at the initial assessment, approximately half of them had diabetic retinopathy or nephropathy (61.5% and 51.8%, respectively), and peripheral artery disease was uncommon (8.6%). Thirty-eight patients (47.5%) experienced one or more relevant clinical events: 22 (27.5%) a new foot ulcer; 7 (8.7%) a major amputation; 20 (25%) were admitted to hospital; and 4 (5%) died. Only the presence of diabetic nephropathy was independently associated to development of any of the complications studied (p = 0.009; odds ratio = 3.37; 95% CI: 1.12-10.1). CONCLUSIONS: Almost half the patients with CN attending specialised foot care units in tertiary hospitals experienced short-term CN-associated complications, and the risk was 3 times higher in those with a history of diabetic nephropathy.
Authors: Viviane Gratwohl; Thorsten Jentzsch; Madlaina Schöni; Dominik Kaiser; Martin C Berli; Thomas Böni; Felix W A Waibel Journal: Arch Orthop Trauma Surg Date: 2021-04-07 Impact factor: 2.928