Increased Mortality in Diabetic Foot Ulcer Patients: The Significance of Ulcer Type.

N K Chammas,R L R Hill,M E Edmonds

doi:10.1155/2016/2879809

N K Chammas, R L R Hill + Show 1 more

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https://doi.org/10.1155/2016/2879809

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Abstract

Diabetic foot ulcer (DFU) patients have a greater than twofold increase in mortality compared with nonulcerated diabetic patients. We investigated (a) cause of death in DFU patients, (b) age at death, and (c) relationship between cause of death and ulcer type. This was an eleven-year retrospective study on DFU patients who attended King's College Hospital Foot Clinic and subsequently died. A control group of nonulcerated diabetic patients was matched for age and type of diabetes mellitus. The cause of death was identified from death certificates (DC) and postmortem (PM) examinations. There were 243 DFU patient deaths during this period. Ischaemic heart disease (IHD) was the major cause of death in 62.5% on PM compared to 45.7% on DC. Mean age at death from IHD on PM was 5 years lower in DFU patients compared to controls (68.2 ± 8.7 years versus 73.1 ± 8.0 years, P = 0.015). IHD as a cause of death at PM was significantly linked to neuropathic foot ulcers (OR 3.064, 95% CI 1.003–9.366, and P = 0.049). Conclusions. IHD is the major cause of premature mortality in DFU patients with the neuropathic foot ulcer patients being at a greater risk.

Highlights

There is strong epidemiological evidence of excess mortality in association with the diabetic foot syndrome
Causes of death were established for deaths occurring between April 1989 and January 2000 from the following: (a) death certificates obtained from the central register for England and Wales held in Southport through the Family Record Centre in London
Death certificates confirmed that 187 diabetic foot ulcer (DFU) (77%) subjects died in hospital

Summary

Introduction

There is strong epidemiological evidence of excess mortality in association with the diabetic foot syndrome. There is a greater than twofold increase of mortality in diabetic foot ulcer (DFU) patients compared to nonulcerated diabetic patients, regardless of age, type and duration of diabetes, treatment of diabetes, glycated haemoglobin concentration, history of lower extremity amputation, and cumulative pack years of cigarette use [1]. Reported mortality rates for diabetic foot ulcer (DFU) patients range from ≈10% on a median follow-up of 16 months [3] to 24% after 5 years [4]. A study from a Liverpool foot clinic indicated a 5-year mortality rate as high as 44% in patients presenting with new DFUs [5]. A large community based Norwegian study over a 10-year follow-up period reported an increased mortality of 49%

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