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Survival and associated risk factors in patients with diabetes and amputations caused by infectious foot gangrene.
J Foot Ankle Res 2018; 11:1JF

Abstract

Background

Infectious gangrene of the foot is a serious complication of diabetes that usually leads to a certain level of lower-extremity amputation (LEA). Nevertheless, the long-term survival and factors associated with mortality in such patients have yet to be elucidated.

Methods

A total of 157 patients with type 2 diabetes who received treatment for infectious foot gangrene at a major diabetic foot center in Taiwan from 2002 to 2009 were enrolled, of whom 90 had major LEAs (above the ankle) and 67 had minor LEAs (below the ankle). Clinical data during treatment were used for the analysis of survival and LEA, and survival was tracked after treatment until December 2012.

Results

Of the 157 patients, 109 died, with a median survival time of 3.12 years and 5-year survival rate of 40%. Age [hazard ratio 1.04 (95% confidence interval 1.01-1.06)], and major LEA [1.80 (1.05-3.09)] were independent factors associated with mortality. Patients with minor LEAs had a better median survival than those with major LEAs (5.5 and 1.9 years, respectively, P < 0.01). An abnormal ankle-brachial index was an independent risk factor [odds ratio 3.12 (95% CI 1.18-8.24)] for a poor outcome (major LEA) after adjusting for age, smoking status, hypertension, major adverse cardiac events, and renal function.

Conclusions

Efforts to limit amputations below the ankle resulted in better survival of patients with infectious foot gangrene. An abnormal ankle-brachial index may guide physicians to make appropriate decisions with regards to the amputation level.

Authors+Show Affiliations

Division of Endocrinology and Metabolism, Department of Internal Medicine, Chang Gung Memorial Hospital, Chang Gung University, 5, Fuxing St., Guishan Dist, Taoyuan City, 333 Taiwan. Department of Medical Nutrition Therapy, Chang Gung Memorial Hospital, Chang Gung University, 5, Fuxing St., Guishan Dist, Taoyuan City, 333 Taiwan.Division of Endocrinology and Metabolism, Department of Internal Medicine, Chang Gung Memorial Hospital, Chang Gung University, 5, Fuxing St., Guishan Dist, Taoyuan City, 333 Taiwan.Division of Endocrinology and Metabolism, Department of Internal Medicine, Chang Gung Memorial Hospital, Chang Gung University, 5, Fuxing St., Guishan Dist, Taoyuan City, 333 Taiwan.Division of Endocrinology and Metabolism, Department of Internal Medicine, Chang Gung Memorial Hospital, Chang Gung University, 5, Fuxing St., Guishan Dist, Taoyuan City, 333 Taiwan.Division of Endocrinology and Metabolism, Department of Internal Medicine, Chang Gung Memorial Hospital, Chang Gung University, 5, Fuxing St., Guishan Dist, Taoyuan City, 333 Taiwan.

Pub Type(s)

Journal Article

Language

eng

PubMed ID

29312468

Citation

Huang, Yu-Yao, et al. "Survival and Associated Risk Factors in Patients With Diabetes and Amputations Caused By Infectious Foot Gangrene." Journal of Foot and Ankle Research, vol. 11, 2018, p. 1.
Huang YY, Lin CW, Yang HM, et al. Survival and associated risk factors in patients with diabetes and amputations caused by infectious foot gangrene. J Foot Ankle Res. 2018;11:1.
Huang, Y. Y., Lin, C. W., Yang, H. M., Hung, S. Y., & Chen, I. W. (2018). Survival and associated risk factors in patients with diabetes and amputations caused by infectious foot gangrene. Journal of Foot and Ankle Research, 11, p. 1. doi:10.1186/s13047-017-0243-0.
Huang YY, et al. Survival and Associated Risk Factors in Patients With Diabetes and Amputations Caused By Infectious Foot Gangrene. J Foot Ankle Res. 2018;11:1. PubMed PMID: 29312468.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Survival and associated risk factors in patients with diabetes and amputations caused by infectious foot gangrene. AU - Huang,Yu-Yao, AU - Lin,Cheng-Wei, AU - Yang,Hui-Mei, AU - Hung,Shih-Yuan, AU - Chen,I-Wen, Y1 - 2018/01/04/ PY - 2017/07/25/received PY - 2017/12/19/accepted PY - 2018/1/10/entrez PY - 2018/1/10/pubmed PY - 2018/9/18/medline KW - Diabetes KW - Infectious foot gangrene KW - Lower-extremity amputation KW - Survival SP - 1 EP - 1 JF - Journal of foot and ankle research JO - J Foot Ankle Res VL - 11 N2 - Background: Infectious gangrene of the foot is a serious complication of diabetes that usually leads to a certain level of lower-extremity amputation (LEA). Nevertheless, the long-term survival and factors associated with mortality in such patients have yet to be elucidated. Methods: A total of 157 patients with type 2 diabetes who received treatment for infectious foot gangrene at a major diabetic foot center in Taiwan from 2002 to 2009 were enrolled, of whom 90 had major LEAs (above the ankle) and 67 had minor LEAs (below the ankle). Clinical data during treatment were used for the analysis of survival and LEA, and survival was tracked after treatment until December 2012. Results: Of the 157 patients, 109 died, with a median survival time of 3.12 years and 5-year survival rate of 40%. Age [hazard ratio 1.04 (95% confidence interval 1.01-1.06)], and major LEA [1.80 (1.05-3.09)] were independent factors associated with mortality. Patients with minor LEAs had a better median survival than those with major LEAs (5.5 and 1.9 years, respectively, P < 0.01). An abnormal ankle-brachial index was an independent risk factor [odds ratio 3.12 (95% CI 1.18-8.24)] for a poor outcome (major LEA) after adjusting for age, smoking status, hypertension, major adverse cardiac events, and renal function. Conclusions: Efforts to limit amputations below the ankle resulted in better survival of patients with infectious foot gangrene. An abnormal ankle-brachial index may guide physicians to make appropriate decisions with regards to the amputation level. SN - 1757-1146 UR - https://www.unboundmedicine.com/medline/citation/29312468/Survival_and_associated_risk_factors_in_patients_with_diabetes_and_amputations_caused_by_infectious_foot_gangrene_ L2 - https://jfootankleres.biomedcentral.com/articles/10.1186/s13047-017-0243-0 DB - PRIME DP - Unbound Medicine ER -