Incidence of death and amputation in patients with a first diabetic foot ulcer: results from the CODIA cohort

Abstract

Aim

- To investigate the incidences of death and lower limb amputation (LLA) among patients hospitalized with a first diabetic foot ulcer and to identify the associated risk factors.

Methods

- We leveraged medical records from 08/2017 to 10/2023 in the clinical data warehouse of the Greater Paris Hospitals. The primary outcome was the cumulative incidence of death estimated at 12 months. We used Kaplan-Meier and Aalen-Johansen estimators to assess the incidence of death and LLA (identified through ICD-10 codes). We used multivariate Cox regression and Fine and Gray models to estimate risk factors (clinical/biological data, medications, and comorbidities at baseline) for death and LLA, accounting for death as a competing event.

Results

- 3102 patients were included; the median age was 70.66 years and there were 67.64% males. The cumulative incidence of death at 12 months was 21.64% [95%CI 20.11;23.26]. Mortality risk was associated with older age, chronic cardiac, hepatic, or renal diseases, cancer history, and systemic inflammation, whereas being overweight was linked to lower mortality. The cumulative incidence of LLA at 12 months was 24.15% [22.54;25.79]. Risk factors for LLA included male sex, history of peripheral artery disease, emergency admission, and systemic inflammation markers, while dementia was associated with a lower risk.

Conclusion

- Cumulative incidences of all-cause mortality and LLA during the months following hospitalization with a first diabetic foot ulcer were alarmingly high. Mortality risk was primarily associated with patient comorbidities, while amputation risk was closely associated with systemic inflammation and history of peripheral artery disease.