Consulta multidisciplinar do pé diabético – avaliação dos fatores de mau prognóstico

Abstract

IntroductionDiabetes mellitus is responsible for 70% of non‐traumatic lower limb amputations and 85% of these are precipitated by ulcers. Objective ‐ epidemiological characterization and revision of the outcome of patients observed in a multidisciplinary outpatient clinic of diabetic foot. Matherials and methodsA retrospective observational study with review of the first consultation of the multidisciplinary outpatient clinic of diabetic foot ulcer, during one semester. Review of the clinical process and evaluation of the epidemiological characteristics, clinical investigation, diagnostic tests, and outcome (healing, major amputation, non‐healing after 1 year or death). ResultsThere were 361 first consultations during the study period, 82.3% due to ulceration (31.3% with neuropathic etiology and 68.7% with neuroischemic foot ulcers). Of the patients followed, 78% achieved complete wound healing (with or without minor amputation), 7.7% did not heal after one year of follow up, 10.1% underwent major limb amputation, and 4.2% died during the follow‐up. Patients with peripheral arterial disease were less likely to heal (70.6% vs. 89.4%, p=0.004) and had greater risk of major amputation (15.7% vs. 1.5%, p=0.003). Nephropathy decreases the likelihood of healing (50% vs. 82.6%, p=0.008) and increases the risk of major amputation (29.1% vs. 6.9%, p=0.008). Non‐ambulatory patients have a higher risk of major amputation (22.9% vs. 6.8%, p=0.008). ConclusionsSuccessful treatment of diabetic foot ulcers requires a multidisciplinary approach, intervening in all etiological components. Peripheral arterial disease, renal failure and non ambulatory status are factors related to poor prognosis of diabetic foot ulcers.