Risk Factors for Major Lower Limb Amputation in Patients with Diabetic Foot Wound

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Category: Diabetes; Other Introduction/Purpose: Diabetic foot wound (DFW) is a relatively common diabetic complication and the leading cause of lower extremity amputation (LEA). Major LEA, such as below-knee or above knee amputations result in more physical disabilities and poorer socioeconomic functions than minor LEA, such as foot and phalangeal amputations. Peripheral arterial occlusive disease (PAOD) considered an important predictor of overall outcomes of DFW. The identification of risk factors for major LEA and investigation of effectiveness of revascularization treatment are critical for prevention and better prognosis of DFW patients. Methods: From January 2014 to December 2019, the study includes a total of 125 patients with DFW treated with any level of amputation. Demographic, diabetes-related, DFW related and relevant laboratory information were investigated to predict major amputation. To identify the risk factor for major amputation, logistic regression analysis was performed for each variable. The effectiveness of revascularization treatment was analyzed by Kaplan-Meier survival curves. Results: Multivariate logistic regression analysis indicated that DM duration (OR, 1.173; 95% CI, 1.073~1.282; p=0.001), PAOD (OR, 22,563; 95% CI, 2.270~93.282; p=0.008), previous amputation (OR, 8.460; 95% CI, 2.369~30.203; p=0.001), abscess (OR, 4.703; 95% CI, 1.275~17.341; p=0.020), Wagner classification grade (OR, 9.349; 95% CI, 2.512~34.794; p=0.001), CRP (OR, 1.143; 95% CI, 1.058~1.235; p=0.001) and albumin (OR, 0.344; 95% CI, 0.129~0.917; p=0.033) were significant risk factors in DFW patients. The major amputation free survival rate at 5 years was 97.4% in non-PAOD group, 49.0% in PAOD with non-revascularization group and 79.0% in PAOD with revascularization group. Moreover, there was statistically significant difference (p=0.001) Conclusion: Among various potential risk factors, the study results concluded that duration of DM, PAOD, previous history of amputation, presence of Abscess, Wagner grade (greater than 3), and such laboratory markers as CRP and albumin, are major risk factors predictive of major LEA in DFW patients. The most valuable and critical finding from the current study is that revascularization in diabetic foot patients with PAOD significantly improved major amputation-free survival rates.