Abstract
BackgroundDiabetic foot ulcers (DFU) are a common problem in longstanding diabetes. However, mortality outcomes in Australian patients with DFU are still unclear.MethodsAll patients with DFU presenting for the first time to the Multi-Disciplinary Foot Clinic (MDFC) at Royal Darwin Hospital, Northern Territory Australia, between January 2003 and June 2015 were included in this study. These patients were followed until 2017, or death. Individual patient data was extracted from hospital and primary care information systems. Kaplan-Meier survival curves were developed. The association between various risk factors and mortality was analysed using Cox regression.ResultsIn total 666 subjects were screened, and 513 were included in the final analysis. Of these subjects, 247 were Indigenous and 266 were non-Indigenous. The median follow-up period was 5.8 years (IQR, 3.1–9.8). The mean age at inclusion was 59.9 ± 12.3 years and 62.8% were males. The majority (93.6%) had type 2 diabetes and the median diabetes duration was 7 years (IQR, 3–12). There were 199 deaths, with a 5-year-mortality rate of 24.6%, and a 10-year-mortality rate of 45.4%. The mean age at death was 64.6 ± 11.8 years. In a multivariate analysis, the following variables were associated with mortality (adjusted HR, 95% CI): age 1.04 (1.02–1.05, P < 0.001); chronic kidney disease 1.22 (1.11–1.33, P < 0.001), and plasma albumin 0.96 (0.94–0.99, P < 0.05). The most common causes of death were chronic kidney disease (24.6%), cardiovascular events (19.6%), sepsis (15.6%), respiratory failure (10.0%), malignancy (9.5%) and multi-organ failure (5.0%).ConclusionPatients with DFU have high mortality. Age, chronic kidney disease, and low albumin levels increase the risk of mortality. Strategies should focus on ulcer prevention and aggressive risk factor reduction.
Highlights
Diabetic foot ulcers (DFU) are a common problem in longstanding diabetes
The major risk factors for death were age, male gender, peripheral vascular disease, and renal disease. It is not known whether DFU are a surrogate marker for more advanced micro- and macro-vascular disease of diabetes mellitus (DM), or if they contribute independently to mortality due to inflammatory sequelae [7]
This is a retrospective study of all patients of over the age of 18-years with DFU, presenting for the first time to the Multi-Disciplinary Foot Clinic (MDFC) at Royal Darwin Hospital (RDH) between January 2003 and June 2015
Summary
Diabetic foot ulcers (DFU) are a common problem in longstanding diabetes. Up to 25% of patients with DM develop diabetic foot ulcers (DFU) over their lifetime [1,2,3]. These patients have a greater than two-fold increase in mortality compared to patients with diabetes. The major risk factors for death were age, male gender, peripheral vascular disease, and renal disease It is not known whether DFU are a surrogate marker for more advanced micro- and macro-vascular disease of DM, or if they contribute independently to mortality due to inflammatory sequelae [7]. Few studies have explored the relationship between DFU and cause-specific mortality
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