Ashu Rastogi1, Ghanshyam Goyal2, Rajesh Kesavan3, Arun Bal4, Anil Bhansali5, Harish Kumar4, Priyatham Kamath4, Edward B Jude6, David G Armstrong7. 1. Deptt. of Endocrinology, PGIMER, Chandigarh, India. Electronic address: ashuendo@gmail.com. 2. ILS Hospital, Salt Lake, Kolkata, India; SVS Marwari hospital, Amhesrst street, Kolkata, India. 3. Hycare for Wounds, Chennai, India. 4. Deptt. of Endocrinology, Amrita Institute of Medical Sciences, Kochi, India. 5. Deptt. of Endocrinology, PGIMER, Chandigarh, India. 6. Tameside Hospital, NHS Foundation and Trust, Ashton under Lyne, Manchester, UK. 7. Keck school of medicine of University of Southern California, Los Angeles, USA.
Abstract
AIMS: This long-term prospective study evaluated limb amputation and mortality after the first neuropathic DFU. METHODS: A total of 2880 patients with neuropathic DFU (DFU group) and a similar number of patients of diabetes without DFU (nDFU) matched for age and diabetes duration were prospectively assessed at five referral-centers over 14 years. Pre-defined outcome was death during follow-up. Various diabetic co-morbidities and amputation were assessed as mortality predictors. RESULTS: Overall, 501 (17.4%) patients in DFU group died compared to 89 (3.1%) (p<0.01) in nDFU group during a median follow-up of 7(1-14) years . The 5- and 10-year mortality was 22% and 71% in the DFU group with a median survival of 7.72 (7.37-8.08) years compared to 3% (p<0.01) and 5% (p<0.01) and survival of 12.6 (10.5-12.7) years (p<0.001) in nDFU group. 29.3% patients had limb amputations. The mortality risk was independent of glycemic control [OR 1.03 (0.80-1.32; p=0.83)]. However, diabetes duration > 10 years [OR 1.31(1.02-1.70, p=0.035)], nephropathy [OR 1.47 (1.04-2.09, p<0.030)], minor 1.85 (1.40-2.44; p<0.001) or major amputation 2.96 (2.01-4.34, p<0.001)] predicted mortality. CONCLUSIONS: Every one-in-three individual with neuropathic DFU has amputation and every sixth individual has an early demise. Prevalent nephropathy and incident amputation following DFU predicts mortality.
AIMS: This long-term prospective study evaluated limb amputation and mortality after the first neuropathic DFU. METHODS: A total of 2880 patients with neuropathic DFU (DFU group) and a similar number of patients of diabetes without DFU (nDFU) matched for age and diabetes duration were prospectively assessed at five referral-centers over 14 years. Pre-defined outcome was death during follow-up. Various diabetic co-morbidities and amputation were assessed as mortality predictors. RESULTS: Overall, 501 (17.4%) patients in DFU group died compared to 89 (3.1%) (p<0.01) in nDFU group during a median follow-up of 7(1-14) years . The 5- and 10-year mortality was 22% and 71% in the DFU group with a median survival of 7.72 (7.37-8.08) years compared to 3% (p<0.01) and 5% (p<0.01) and survival of 12.6 (10.5-12.7) years (p<0.001) in nDFU group. 29.3% patients had limb amputations. The mortality risk was independent of glycemic control [OR 1.03 (0.80-1.32; p=0.83)]. However, diabetes duration > 10 years [OR 1.31(1.02-1.70, p=0.035)], nephropathy [OR 1.47 (1.04-2.09, p<0.030)], minor 1.85 (1.40-2.44; p<0.001) or major amputation 2.96 (2.01-4.34, p<0.001)] predicted mortality. CONCLUSIONS: Every one-in-three individual with neuropathic DFU has amputation and every sixth individual has an early demise. Prevalent nephropathy and incident amputation following DFU predicts mortality.
Authors: Erika A Petersen; Thomas G Stauss; James A Scowcroft; Elizabeth S Brooks; Judith L White; Shawn M Sills; Kasra Amirdelfan; Maged N Guirguis; Jijun Xu; Cong Yu; Ali Nairizi; Denis G Patterson; Kostandinos C Tsoulfas; Michael J Creamer; Vincent Galan; Richard H Bundschu; Neel D Mehta; Dawood Sayed; Shivanand P Lad; David J DiBenedetto; Khalid A Sethi; Johnathan H Goree; Matthew T Bennett; Nathan J Harrison; Atef F Israel; Paul Chang; Paul W Wu; Charles E Argoff; Christian E Nasr; Rod S Taylor; David L Caraway; Nagy A Mekhail Journal: Mayo Clin Proc Innov Qual Outcomes Date: 2022-07-01
Authors: Brian M Schmidt; Michael E Munson; Gary M Rothenberg; Crystal M Holmes; Rodica Pop-Busui Journal: J Diabetes Complications Date: 2020-07-28 Impact factor: 2.852