Mortality in Patients with Diabetic Foot Ulcers: Causes, Risk Factors, and Their Association with Evolution and Severity of Ulcer
Abstract
:1. Introduction
2. Materials and Methods
2.1. Description of the Multidisciplinary Diabetic Foot Team
2.2. Data Collection and Processing
2.3. Data Reporting and Statistical Analysis
2.4. Ethical Issues
3. Results
4. Discussion
4.1. Global Mortality
4.2. Cardiovascular Disease as a Cause of Death
4.3. Diabetic Foot Ulcer as a Cause of Death
4.4. Predictive Factors for Mortality
4.4.1. Glycemic Control
4.4.2. Ulcer Severity
4.4.3. Revascularization
4.4.4. Reulceration
4.4.5. Limitations and Strengths
5. Conclusions
Author Contributions
Funding
Acknowledgments
Conflicts of Interest
References
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Median (Q25–Q75) | Range | |
---|---|---|
Age in years | 71 (62–80) | 32–95 |
Years since diagnosis | 14 (8–23) | 0–56 |
HbA1c (%) a | 7.9 (6.7–9.1) | 4.1–13.7 |
HbA1c (mmol/mol) a | 63 (50–76) | 21–126 |
BMI (Kg/m2) | 27.7 (24.9–31.1) | 18–50 |
N | % | |
Type of DM | ||
T1DM | 18 | 5.3 |
T2DM | 314 | 92.9 |
Other types of DM | 6 | 1.8 |
Sex | ||
Males | 221 | 65.4 |
Females | 117 | 34.6 |
Smoking | ||
Never | 168 | 49.7 |
Former smoker | 109 | 32.2 |
Current smoker | 61 | 18.0 |
Alcohol intake (♀ > 25 g/day. ♂ > 40 g/day) | ||
Never | 246 | 72.8 |
Former alcohol intake | 51 | 15.1 |
Current alcohol intake | 41 | 12.1 |
Treatment of hyperglycemia | ||
Dietetic treatment alone | 17 | 5.0 |
Oral antidiabetic drugs or injections non-insulin | 121 | 35.8 |
Insulin alone or with other treatments for hyperglycemia | 200 | 59.2 |
Past ulcer | 139 | 41.1 |
History of peripheral artery disease | 109 | 32.2 |
Past amputation | 53 | 15.6 |
Major | 15 | 4.4 |
Minor | 38 | 11.2 |
Retinopathy | 194 | 57.4 |
Chronic kidney disease | 148 | 43.8 |
Glomerular filtration rate (GFR) | ||
GFR > 60 mL/min | 252 | 74.6 |
GFR 60–30 mL/min | 57 | 16.9 |
GFR < 30 mL/min | 12 | 3.6 |
Dialysis | 17 | 4.4 |
Post-transplantation | 2 | 0.6 |
Hypertension | 272 | 80.5 |
Ischemic heart disease or cerebrovascular disease | 160 | 47.3 |
Ischemic heart disease | 133 | 39.3 |
Cerebrovascular disease | 56 | 16.6 |
Sensory neuropathy | 254 | 75.1 |
Ischemic lesion | 167 | 49.4 |
N | % | |
---|---|---|
Cardiovascular disease | 110 | 54.7 |
Ischemic heart disease | 25 | 12.4 |
Heart failure | 20 | 19 |
Cerebrovascular disease | 8 | 4 |
Probable cardiovascular cause. Unexpected death occurring outside hospital | 57 | 28.4 |
Respiratory disease with or without infection | 38 | 18.9 |
Multiorgan failure or sepsis associated with DFU | 11 | 5.5 |
Multiorgan failure or sepsis from other causes | 14 | 7 |
End-stage chronic kidney disease | 12 | 6 |
Cancer | 12 | 6 |
Other | 4 | 2 |
Unadjusted | Adjusted Model 1 | Adjusted Model 2 | ||||
---|---|---|---|---|---|---|
HR (95% CI) | p-Value | HR (95% CI) | p-Value | HR (95% CI) | p-Value | |
Age | 1.06 (1.04–1.07) * | <0.001 | 1.07 (1.05–1.09) * | <0.001 | 1.07 (1.05–1.08) * | <0.001 |
Male vs. female | 1.09 (0.81–1.46) | 0.544 | 1.27 (0.92–1.74) | 0.135 | 1.28 (0.92–1.77) | 0.140 |
T2DM vs. T1DM | 2.47 (1.16–5.26) * | 0.019 | 0.92 (0.38–2.21) | 0.866 | 0.97 (0.40–2.35) | 0.951 |
Years since diagnosis | 1.01 (1.00–1.02) * | 0.029 | 1.00 (0.99–1.01) | 0.435 | 1.00 (0.99–1.02) | 0.228 |
HbA1c (%) at first consultation | 0.89 (0.82–0.97) * | 0.008 | 0.95 (0.87–1.03) | 0.262 | 0.93 (0.85–1.02) | 0.175 |
HbA1c < 7 (%)/53 (mmol/mol) vs. ≥ 7 (%)/53 (mmol/mol) | 1.71 (1.27–2.29) * | <0.001 | 1.37 (0.99–1.90) | 0.056 | 1.43 (1.02–2.0) * | 0.035 |
BMI (Kg/m2) | 0.97 (0.94–1.00) | 0.121 | 0.96 (0.93–1.00) | 0.05 | 0.97 (0.94–1.01) | 0.152 |
Current smoker | 0.80 (0.55–1.16) | 0.244 | 1.54 (1.01–2.32) * | 0.04 | 1.59 (1.02–2.47) * | 0.038 |
Ischemic heart disease or cerebrovascular disease | 2.10 (1.58–2.78) * | <0.001 | 1.70 (1.27–2.27) * | 0.04 | 1.55 (1.15–2.11) * | 0.004 |
Ischemic heart disease | 1.91 (1.45–2.53) * | <0.001 | 1.49 (1.11–1.98) * | 0.006 | 1.35 (1.0–1.82) * | 0.049 |
Cerebrovascular disease | 1.38 (0.97–1.97) | 0.07 | 1.09 (0.75–1.57) | 0.635 | 1.11 (0.76–1.64) | 0.569 |
Hypertension | 1.55 (1.04–2.29) | 0.029 | 1.08 (0.71–1.83) | 0.708 | 1.15 (0.75–1.78) | 0.507 |
Chronic kidney disease | 1.68 (1.27–2.21) * | <0.001 | 1.73 (1.3–2.32) * | <0.001 | 1.86 (1.37–2.53) * | <0.001 |
Grouped GFR (1 = >60 mL/min, 2 = 30–60 mL/min, and 3 = <30 mL/min or on dialysis) | 1.62 (1.32–1.98) * | <0.001 | 1.47 (1.19–1.82) * | <0.001 | 1.51 (1.21–1.89) * | <0.001 |
Retinopathy | 0.80 (0.59–1.07) | 0.8 | 0.82 (0.59–1.13) | 0.232 | 0.82 (0.59–1.14) | 0.255 |
Past amputation | 1.32 (0.92–1.89) | 0.125 | 1.26 (0.92–1.73) | 0.137 | 1.35 (0.89–2.05) | 0.152 |
Major | 2.36 (1.31–4.25) * | 0.004 | 1.89 (1.04–3.45) * | 0.037 | 1.48 (0.75–2.90) | 0.252 |
Minor | 1.04 (0.68–1.59) | 0.825 | 1.41 (0.91–2.19) | 0.118 | 1.23(0.76–2.00) | 0.385 |
History of peripheral artery disease | 1.47 (1.15–1.96) * | 0.007 | 0.99 (0.72–1.37) | 0.973 | 0.96 (0.68–1.35 | 0.817 |
Sensory neuropathy a | 0.75 (0.55–1.02) | 0.068 | 0.88 (0.64–1.23) | 0.48 | 0.75 (0.53–1.07) | 0.758 |
Ischemic lesion b | 2.2 (1.65–2.93) * | <0.001 | 1.27 (0.93–1.74) | 0.128 | 1.25 (0.90–1.73) | 0.182 |
Score SINBAD system | 1.19 (1.08–1.32) * | <0.001 | 1.14 (1.01–1.27) * | 0.023 | 1.12 (1.02–1.26) * | 0.046 |
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Rubio, J.A.; Jiménez, S.; Lázaro-Martínez, J.L. Mortality in Patients with Diabetic Foot Ulcers: Causes, Risk Factors, and Their Association with Evolution and Severity of Ulcer. J. Clin. Med. 2020, 9, 3009. https://doi.org/10.3390/jcm9093009
Rubio JA, Jiménez S, Lázaro-Martínez JL. Mortality in Patients with Diabetic Foot Ulcers: Causes, Risk Factors, and Their Association with Evolution and Severity of Ulcer. Journal of Clinical Medicine. 2020; 9(9):3009. https://doi.org/10.3390/jcm9093009
Chicago/Turabian StyleRubio, José Antonio, Sara Jiménez, and José Luis Lázaro-Martínez. 2020. "Mortality in Patients with Diabetic Foot Ulcers: Causes, Risk Factors, and Their Association with Evolution and Severity of Ulcer" Journal of Clinical Medicine 9, no. 9: 3009. https://doi.org/10.3390/jcm9093009