Factores de riesgo de complicaciones vasculares en extremidades inferiores en los pacientes con diabetes

Abstract

Background and Objetive To evaluate the risk factors of complications in lower limbs in diabetic patients. Patients and methods We evaluated 270 patients with diabetes followed in Hospital la Paz from 2000 to 2008.We measured the ankle-brachial index (ABI), toe-brachial index (TBII), and toe blood pressure (BP). We defined vascular complications in lower limbs. We compared some epidemiological and clinical variables between patients with and without a vascular event. We analyzed which variables have an independent association with the later appearance of a vascular event with Cox regression model. Results The mean value of ITB, IDB and toe blood pressure were significantly lower in patients who had a vascular event compared to those who had not presented it (ITB mean 0.92 ± 0.30 vs 0.78 ± 0.46, P = .007; IDB mean 0.86 ± 4.40 vs 0.42 ± 0.22, P = .001; PA mean 72.08 ± 30.62 vs 56.25 ± 29.51, P = .014).The association of vascular event and biomechanical abnormalities ( P = .022), active and old ulcers ( P = .000), and insensivity ( P = .023) were significantly. In the Cox regression model the toe brachial index (HR 0.05; IC:0.00-0.52; P = .013), the active (HR 3.26; IC:1.37-7.79; P = .008) and old ulcers (HR 5.55; IC:1.85-16.59; P = .002). and the biomechanical abnormalities (HR 4.92; IC:1.13-18.75; P = .019) had an independent value. Conclusions Toe brachial index, biomechanical abnormalities and ulcers have an independent value to predict the later appearance of vascular events. In addition, they are independent of the age, type of diabetes and others diabetic complications.