Clinical outcomes of patients with Polyvascular disease admitted with an acute diabetic foot ulcer

Abstract

Aims

Diabetic foot ulcer (DFU) is a common cause of admission in patients with diabetes. Diabetes increases the likelihood of inpatient Major Adverse Cardiovascular Events (MACE), and the presence of polyvascular disease (PD), defined by the presence of atherosclerosis in two or more arterial beds, further amplifies this risk. We assessed the impact of PD on outcomes in patients admitted due to a DFU.

Methods

In this retrospective single-center study, we enrolled adult patients admitted to the diabetic foot unit between 2014 and 2019. The primary outcome was a composite of inpatient MACE or death. Secondary outcomes included amputations, leg revascularization, duration of admission and 1-year mortality. We additionally collected survival data till the end of 2023.

Results

A total of 537 patients were enrolled in the study, 264 suffering of PD. The primary endpoint occurred in 12.5 % and 4.4 % of patients with vs. without PD (p = 0.001). Patients with PD had an increased incidence of vascular interventions (42 % vs. 19.4 %, p < 0.001), any amputation (67.4 % vs. 48.4 %, p < 0.001) and major amputation (35.6 % vs. 13.2 %, p < 0.001). They had longer admissions (median 19 vs. 17 days, p = 0.002) and higher 1-year mortality rates (33.0 % vs. 12.1 %, p < 0.001). During 10-year follow up (median 3.3 years) median survival was 2.0 vs. 5.9 years for patients with vs. without PD (p < 0.001).

Conclusions

PD in patients admitted with a DFU is associated with poor inpatient and long-term outcomes. This highlights the need for comprehensive risk assessment, optimization of in-patient management and long-term control of cardiovascular risk factors.