IDF21-0287 Validation of a Simple Scoring System predicting Amputation in Patients with Diabetic Foot

Abstract

Background: Diabetic foot disease (DFD) is one of the most serious complications of diabetes with high mortality and reduction in quality of life. Diabetics are 10-30 times more prone to have lower limb amputation compared to non-diabetics and nearly 70% amputation occur in diabetics. Lower extremity amputation (LEA) is always preceded by poorly healing foot ulceration in 85% cases. There is wide variability in prevalence of lower extremity amputation in patients with diabetic foot ulcer (DFU) ranging from 0.86% in USA to 12-48% in Pakistan. Many risk factors predicting amputation has been cited in literature but several inconsistencies in results between these studies has been observed. If the risk factors are assessed, scored and then aggregated to a final sum so that a large overall score correlates with higher risk of amputation. Method: 2.1. Study Area and Period. This study was conducted in Liaquat Medical University Hospital from 06-08-2017 to 07 – 09-2019. 2.2. Study Design. Cross-Sectional Descriptive. 2.3. Inclusion Criteria: This study included 113 consecutive patients > 18 years of age of either sex with DFU attending outpatient department or admitted through emergency department. 2.4. Exclusion Criteria: Foot with peripheral artery disease not associated with diabetes mellitus, traumatic foot ulcers, patients with psychiatric illness, gestational diabetes. Results: Among 114 diabetic patients 90 (78.9 %) were male and 24 (21.1%) female. Sensory neuropathy of varying degrees was present in 107 (93.8%) patients. Amputation was performed in 36 (31.6%) whereas 78 (68.4%) patients improved. A strong relationship was found between rate of amputation with score system as higher rate of amputation was found in patients with score > 16. The other factors, age duration of diabetes and HBA1c, depth of ulcer, ABI and infection whereas poor relation with sex. Discussion: According to abhijet et.al 68.1% had sensory neuropathy who had amputation. Uysal S, et al in prospective study comprising 379 patients with DFU observed amputation in 126 (33.2%) cases. Alder Al et al in their review consisting of 14 studies comprising 94640 patients found a strong association between hyperglycemia and for each one percentage increment in HBA1c risk of amputation increases by 1.3 times. Oyibo et al in their study observed a significant correlation between Wagner grade and risk of amputation. Armstrong et al observed a 11 fold increment in major amputation in Wagner grade 3 to 5 compared to grade 1 and 2.