Multidisciplinary management of diabetic foot infection associated with improved 8-year overall survival

IF 2.9 3区医学 Q3 ENDOCRINOLOGY & METABOLISM

Journal of diabetes and its complications Pub Date : 2024-03-03 DOI:10.1016/j.jdiacomp.2024.108719

Miska Vuorlaakso , Verna Karèn , Juha Kiiski , Jorma Lahtela , Ilkka Kaartinen

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引用次数: 0

Abstract

Aims

Diabetic foot syndrome is a global challenge best managed through multidisciplinary collaboration. This study aimed to investigate the effect of a systematic multidisciplinary team (MDT) on the overall survival and major amputation-free survival of hospitalized patients with diabetic foot infection (DFI).

Methods

This retrospective cohort study was conducted at Tampere University Hospital. Cohorts of hospitalized patients with DFI before and after the initiation of multidisciplinary wound ward were compared after an 8-year follow-up.

Results

Kaplan-Meier analysis revealed significantly higher overall survival in the post-MDT cohort (37.8 % vs 22.6 %, p < 0.05) in 8-year follow-up. Similarly, major amputation-free survival was superior in this cohort (31.8 % vs 16.9 %, p < 0.05). Additionally, early major amputation was associated with inferior overall survival (35.1 % vs 12.0 %, p < 0.05). In a multivariable Cox-regression analysis cohort (hazard ratio [HR] 1.38, 95 % confidence interval [CI95%] 1.01–1.87), early amputation (HR 1.64, CI95% 1.14–2.34) and diagnosed peripheral artery disease (HR 2.23, CI95% 1.61–3.09), congestive heart failure (HR 2.13, CI95% 1.47–3.08), or moderate kidney disease (HR 1.95, CI95% 1.34–2.84) were identified as significant risk factors affecting overall survival.

Conclusions

After systematic MDT approach we found improved long-term overall and major amputation-free survival. Multidisciplinary approach is therefore highly recommended for managing patients hospitalized for DFI.

查看原文本刊更多论文

糖尿病足感染的多学科管理可提高 8 年总生存率

糖尿病足综合征是一项全球性挑战，最好通过多学科协作进行管理。本研究旨在探讨系统性多学科团队（MDT）对糖尿病足感染（DFI）住院患者的总体存活率和无重大截肢存活率的影响。这项回顾性队列研究在坦佩雷大学医院进行。经过 8 年的随访，比较了多学科伤口病房启动前后的糖尿病足感染住院患者队列。卡普兰-梅耶尔分析显示，在 8 年随访中，多学科伤口治疗后组群的总生存率明显更高（37.8% 对 22.6%，< 0.05）。同样，该队列的无截肢生存率也更高（31.8% vs 16.9%，< 0.05）。此外，早期大截肢与总生存率较低有关（35.1% vs 12.0%，< 0.05）。在多变量 Cox 回归分析中，队列（危险比 [HR] 1.38，95% 置信区间 [CI95%] 1.01-1.87）、早期截肢（HR 1.64，CI95% 1.14-2.34）和确诊外周动脉疾病（HR 2.23，CI95% 1.61-3.09）、充血性心力衰竭（HR 2.13，CI95% 1.47-3.08）或中度肾脏疾病（HR 1.95，CI95% 1.34-2.84）被认为是影响总生存期的重要危险因素。在采用系统的 MDT 方法后，我们发现患者的长期总生存率和无重大截肢的生存率均有所提高。因此，我们强烈建议采用多学科方法来管理住院治疗的 DFI 患者。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Journal of diabetes and its complications 医学-内分泌学与代谢

CiteScore

5.90

自引率

3.30%

发文量

153

审稿时长

16 days

期刊介绍： Journal of Diabetes and Its Complications (JDC) is a journal for health care practitioners and researchers, that publishes original research about the pathogenesis, diagnosis and management of diabetes mellitus and its complications. JDC also publishes articles on physiological and molecular aspects of glucose homeostasis. The primary purpose of JDC is to act as a source of information usable by diabetes practitioners and researchers to increase their knowledge about mechanisms of diabetes and complications development, and promote better management of people with diabetes who are at risk for those complications. Manuscripts submitted to JDC can report any aspect of basic, translational or clinical research as well as epidemiology. Topics can range broadly from early prediabetes to late-stage complicated diabetes. Topics relevant to basic/translational reports include pancreatic islet dysfunction and insulin resistance, altered adipose tissue function in diabetes, altered neuronal control of glucose homeostasis and mechanisms of drug action. Topics relevant to diabetic complications include diabetic retinopathy, neuropathy and nephropathy; peripheral vascular disease and coronary heart disease; gastrointestinal disorders, renal failure and impotence; and hypertension and hyperlipidemia.