The association of sarcopenia and frailty in diabetes-related foot disease: A 3-year prospective evaluation.

IF 2.5 3区 医学 Q1 ORTHOPEDICS
Kay Yee Hon, Madeleine Bain, Suzanne Edwards, Guilherme Pena, Neil McMillan, Robert Fitridge
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Abstract

Aim: To prospectively evaluate the association of various markers of sarcopenia and frailty with clinical outcomes in diabetes-related foot disease (DRFD), namely wound healing, amputation-free survival, and death over 3 years.

Methods: This was an observational study of patients with DRFD at a quaternary multidisciplinary diabetic foot service. Initial assessment includes classification of DRFDs using WIfI classification, assessment of frailty using the FRAIL scale, and measurement of handgrip strength (HGS) using a dynamometer. Muscle mass was ascertained by measuring the psoas muscle area at the level of L3 vertebrae on computed tomography. Patients were followed up for 3 years and primary outcomes were wound healing, amputation-free survival, and death.

Results: One hundred patients with a median age of 71 were included in the analysis. The majority of the patients were male (75%). Forty-seven percent of patients were considered as frail, with 37 patients recorded to have low HGS. Patients with high HGS had significantly higher odds of wound healing by 3.83 times when compared to those with low HGS (odds ratio = 3.83. 95% CI 1.35-10.92). Patients with low psoas muscle index (PMI) and low HGS were observed to have a higher risk of death based on the following hazard ratios: HGS (high vs. low), HR = 0.46, 95% CI: 0.22-0.997; PMI (low vs. high), HR = 2.15, 95% CI: 1.17-3.96.

Conclusion: There was a significant prevalence of frailty and reduced HGS among our patients with DRFD. Low HGS was associated with poor wound healing and increased mortality in patients with DRFD. Additionally, low muscle mass was associated with increased mortality in this population. This research highlights the need for more precise tests and future studies of the links between sarcopenia, frailty, and outcomes in DRFD.

糖尿病相关足病中肌肉减少症和虚弱的关联:一项3年前瞻性评估
目的:前瞻性评估糖尿病相关性足病(DRFD)临床结局(伤口愈合、无截肢生存和3年以上死亡)与肌肉减少症和虚弱的各种标志物之间的关系。方法:这是一项观察性研究,在第四季度多学科糖尿病足服务的DRFD患者。初步评估包括使用WIfI分类对drfd进行分类,使用虚弱量表评估脆弱性,使用测力计测量握力(HGS)。通过计算机断层扫描测量L3椎水平腰肌面积来确定肌肉质量。患者随访3年,主要结果为伤口愈合、无截肢生存和死亡。结果:100例患者纳入分析,中位年龄为71岁。患者以男性居多(75%)。47%的患者被认为身体虚弱,有37名患者记录为低HGS。高HGS患者的伤口愈合几率是低HGS患者的3.83倍(优势比= 3.83)。95% ci 1.35-10.92)。根据以下风险比,腰大肌指数(PMI)低和HGS低的患者死亡风险更高:HGS(高vs低),HR = 0.46, 95% CI: 0.22-0.997;PMI(低vs高),HR = 2.15, 95% CI: 1.17-3.96。结论:在我们的DRFD患者中存在明显的虚弱患病率和HGS降低。低HGS与DRFD患者的伤口愈合不良和死亡率增加有关。此外,在这一人群中,低肌肉质量与死亡率增加有关。这项研究强调需要更精确的测试和未来研究肌肉减少症、虚弱和DRFD预后之间的联系。
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来源期刊
CiteScore
4.50
自引率
10.30%
发文量
83
审稿时长
>12 weeks
期刊介绍: Journal of Foot and Ankle Research, the official journal of the Australian Podiatry Association and The College of Podiatry (UK), is an open access journal that encompasses all aspects of policy, organisation, delivery and clinical practice related to the assessment, diagnosis, prevention and management of foot and ankle disorders. Journal of Foot and Ankle Research covers a wide range of clinical subject areas, including diabetology, paediatrics, sports medicine, gerontology and geriatrics, foot surgery, physical therapy, dermatology, wound management, radiology, biomechanics and bioengineering, orthotics and prosthetics, as well the broad areas of epidemiology, policy, organisation and delivery of services related to foot and ankle care. The journal encourages submissions from all health professionals who manage lower limb conditions, including podiatrists, nurses, physical therapists and physiotherapists, orthopaedists, manual therapists, medical specialists and general medical practitioners, as well as health service researchers concerned with foot and ankle care. The Australian Podiatry Association and the College of Podiatry (UK) have reserve funds to cover the article-processing charge for manuscripts submitted by its members. Society members can email the appropriate contact at Australian Podiatry Association or The College of Podiatry to obtain the corresponding code to enter on submission.
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