The Amputation Rate and Associated Risk Factors within 1 Year after the Diagnosis of Diabetic Foot Ulcer

Dong-Il Chun; Min Chul Jeon; Sung-Woo Choi; Yong-Beom Kim; Jae-Hwi Nho; Sung Hun Won

doi:10.14193/jkfas.2016.20.3.121

Journal List > J Korean Foot Ankle Soc > v.20(3) > 1043388

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Chun, Jeon, Choi, Kim, Nho, and Won: The Amputation Rate and Associated Risk Factors within 1 Year after the Diagnosis of Diabetic Foot Ulcer

Original Article

J Korean Ophthalmol Soc 2016;20(3):121-125.

Published online: 19 January 2016

DOI: https://doi.org/10.14193/jkfas.2016.20.3.121

The Amputation Rate and Associated Risk Factors within 1 Year after the Diagnosis of Diabetic Foot Ulcer

Dong-Il Chun, Min Chul Jeon, Sung-Woo Choi, Yong-Beom Kim, Jae-Hwi Nho, Sung Hun Won

Department of Orthopaedic Surgery, Soonchunhyang University Seoul Hospital, Seoul, Korea

Corresponding Author: Sung Hun Won Department of Orthopaedic Surgery, Soonchunhyang University Seoul Hospital, 59 Daesagwan-ro, Yongsan-gu, Seoul 04401, Korea Tel: 82-2-709-9250, Fax: 82-2-710-3191, E-mail: orthowon@gmail.com

Received 30 June 201630 July 2016 Accepted 1 August 2016

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/4.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Purpose:

This study investigates the amputation rate within 1 year after the diagnosis of diabetic foot ulcer and its associated risk factors.

Materials and Methods:

This study enrolled 60 patients with diabetic foot ulcer. The mean and standard deviation age was 64.4±12.8 years (range, 32∼89 years); the mean and standard deviation prevalence period for diabetes mellitus was 21.0±7.5 years (range, 0.5∼36 years). The amputation rate was evaluated by dividing the subjects into two groups—the major and minor amputation groups—within 1 year following the initial diagnosis of diabetic foot ulcer. Multivariate Cox proportional hazards regression analysis was used to identify the risk factors for amputation.

Results:

The total amputation rate of 38.3% (n=23) was comprised of the amputation rate for the major amputation group (10.0%) and rate for the minor amputation group (23.8%). There was a high correlation between peripheral artery disease (toe brachial pressure index <0.7) and amputation (hazard ratio [HR] 5.81, confidence interval [CI] 2.09∼16.1, p<0.01). Nephropathy was significantly correlated with the amputation rate (HR 3.53, CI 1.29∼9.64, p=0.01).

Conclusion:

Clinicians who treat patients with diabetic foot complications must understand the fact that the amputation rate within 1 year is significant, and that the amputation rate of patients with peripheral artery disease or nephropathy is especially high.

Keywords: Diabetic foot ulcer, Amputation rate, Risk factor

REFERENCES

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Fig. 1.

Kaplan-Meier curves depending on toe-brachial pressure index (log-rank test p<0.01). TBPI: toe-brachial pressure index.

Fig. 2.

Kaplan-Meier curves depending on nephropathy (log-rank test p<0.01).

Table 1.

Demographic and Clinical Patient Characteristics

Characteristic	Value
Mean age (yr)	64.4±12.8
Sex
Male	34 (56.7)
Female	26 (43.3)
Type of diabetes
Type 1	4 (6.7)
Type 2	56 (93.3)
Treatment
Insulin	29 (48.3)
Tablet	31 (51.7)
Current smoking status
Non- or ex-smoker	34 (56.7)
Smoker	26 (43.3)
Mean duration of diabetes (yr)	21.0±7.5
Mean glycosylated hemoglobin level (%)	7.3±1.2
Wagner classification
Grade 1	26 (43.3)
Grade 2	9 (15.0)
Grade 3	15 (25.0)
Grade 4	10 (16.7)
Grade 5	0
Duration of ulcer (mo)	4.1±2.3
ABPI
≥0.9	39 (65.0)
<0.9	21 (35.0)
TBPI
≥0.7	40 (66.7)
<0.7	20 (33.3)
Complication
Macrovascular	14 (23.3)
Microvascular	21 (35.0)
Nephropathy	24 (40.0)
Neuropathy	46 (76.7)
Cerebrovascular	10 (16.7)
Amputation
Major (above the ankle)	6 (10.0)
Minor (below the ankle)	17 (28.3)

Values are presented as mean±standard deviation or number (%). ABPI: ankle brachial pressure index, TBPI: toe-brachial pressure index.

Table 2.

Univariate Cox Proportional Hazards Regression Models

Explanatory variable	All amputation (n=23)		Major amputation (n=6)		Minor amputation (n=17)
Explanatory variable	HR (95% CI)	p-value	HR (95% CI)	p-value	HR (95% CI)	p-value
Age	1.01 (0.98∼1.05)	0.31	1.05 (0.98∼1.12)	0.15	1.00 (0.97∼1.03)	0.87
Sex (male vs female)	1.67 (0.71∼3.89)	0.23	0.50 (0.16∼1.59)	0.24	1.98 (0.89∼4.44)	0.09
Duration of diabetes	1.03 (0.97∼1.09)	0.33	0.98 (0.93∼1.04)	0.5	0.99 (0.96∼1.02)	0.66
Smoking (current smoker)	1.07 (0.59∼1.97)	0.82	0.03 (0.00∼13.17)	0.28	1.29 (0.69∼2.42)	0.43
ABPI (<0.9)	5.83 (2.27∼14.9)	<0.01	11.11 (1.29∼96.17)	0.02	4.79 (1.66∼13.8)	<0.01
TBPI (<0.7)	7.64 (2.81∼20.7)	<0.01	8.12 (0.96∼52.3)	0.05	5.03 (1.74∼14.5)	<0.01
Severity of ulcer	4.12 (1.61∼10.5)	<0.01	8.07 (0.94∼68.9)	0.05	3.35 (1.16∼9.65)	0.02
Duration of ulcer	1.18 (0.99∼1.40)	0.76	1.00 (0.93∼1.09)	0.89	0.99 (0.94∼1.05)	0.72
HbA1c (>7.5%)	1.06 (0.52∼2.14)	0.87	1.01 (0.32∼3.22)	0.99	0.50 (0.26∼0.95)	0.08
Macrovascular	2.04 (0.78∼5.32)	0.14	2.04 (0.55∼7.59)	0.29	1.10 (0.62∼1.97)	0.74
Microvascular	1.13 (0.46∼2.76)	0.77	0.91 (0.29∼2.89)	0.88	0.67 (0.36∼1.26)	0.22
Nephropathy	5.19 (1.99∼13.5)	<0.01	10.03 (1.17∼86.5)	0.03	4.19 (1.41∼12.47)	0.01
Neuropathy	0.41 (0.14∼1.18)	0.10	24.8 (0.01∼81893.46)	0.44	1.13 (0.44∼2.89)	0.81
Cerebrovascular	1.53 (0.50∼4.60)	0.45	1.16 (0.31∼4.29)	0.83	0.60 (0.27∼1.36)	0.22

HR: hazard ratio, CI: confidence interval, ABPI: ankle brachial pressure index, TBPI: toe-brachial pressure index.

Table 3.

Multivariate Cox Proportional Hazards Regression Models

Explanatory variable	All amputation (n=23)		Major amputation (n=6)		Minor amputation (n=17)
Explanatory variable	HR (95% CI)	p-value	HR (95% CI)	p-value	HR (95% CI)	p-value
ABPI (<0.9)	1.46 (0.27∼7.78)	0.66	1.05 (0.06∼12.3)	0.65	2.02 (0.25∼16.6)	0.51
TBPI (<0.7)	5.81 (2.09∼16.1)	<0.01	5.97 (1.52∼14.9)	0.02	4.07 (1.39∼11.9)	0.01
Severity of ulcer	0.72 (0.17∼2.99)	0.65	0.56 (0.08∼6.36)	0.73	0.84 (0.16∼4.36)	0.83
Nephropathy	3.53 (1.29∼9.64)	0.01	4.23 (1.04∼10.0)	0.04	3.23 (1.04∼10.0)	0.04

HR: hazard ratio, CI: confidence interval, ABPI: ankle brachial pressure index, TBPI: toe-brachial pressure index.

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