Miska Vuorlaakso , Verna Karèn , Juha Kiiski , Jorma Lahtela , Ilkka Kaartinen
{"title":"糖尿病足感染的多学科管理可提高 8 年总生存率","authors":"Miska Vuorlaakso , Verna Karèn , Juha Kiiski , Jorma Lahtela , Ilkka Kaartinen","doi":"10.1016/j.jdiacomp.2024.108719","DOIUrl":null,"url":null,"abstract":"<div><h3>Aims</h3><p>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).</p></div><div><h3>Methods</h3><p>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.</p></div><div><h3>Results</h3><p>Kaplan-Meier analysis revealed significantly higher overall survival in the post-MDT cohort (37.8 % vs 22.6 %, <em>p</em> < 0.05) in 8-year follow-up. Similarly, major amputation-free survival was superior in this cohort (31.8 % vs 16.9 %, <em>p</em> < 0.05). Additionally, early major amputation was associated with inferior overall survival (35.1 % vs 12.0 %, <em>p</em> < 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.</p></div><div><h3>Conclusions</h3><p>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.</p></div>","PeriodicalId":15659,"journal":{"name":"Journal of diabetes and its complications","volume":null,"pages":null},"PeriodicalIF":2.9000,"publicationDate":"2024-03-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S105687272400045X/pdfft?md5=8e80ff85a7cbc3aee38144c09c6e8095&pid=1-s2.0-S105687272400045X-main.pdf","citationCount":"0","resultStr":"{\"title\":\"Multidisciplinary management of diabetic foot infection associated with improved 8-year overall survival\",\"authors\":\"Miska Vuorlaakso , Verna Karèn , Juha Kiiski , Jorma Lahtela , Ilkka Kaartinen\",\"doi\":\"10.1016/j.jdiacomp.2024.108719\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<div><h3>Aims</h3><p>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).</p></div><div><h3>Methods</h3><p>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.</p></div><div><h3>Results</h3><p>Kaplan-Meier analysis revealed significantly higher overall survival in the post-MDT cohort (37.8 % vs 22.6 %, <em>p</em> < 0.05) in 8-year follow-up. Similarly, major amputation-free survival was superior in this cohort (31.8 % vs 16.9 %, <em>p</em> < 0.05). Additionally, early major amputation was associated with inferior overall survival (35.1 % vs 12.0 %, <em>p</em> < 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.</p></div><div><h3>Conclusions</h3><p>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.</p></div>\",\"PeriodicalId\":15659,\"journal\":{\"name\":\"Journal of diabetes and its complications\",\"volume\":null,\"pages\":null},\"PeriodicalIF\":2.9000,\"publicationDate\":\"2024-03-03\",\"publicationTypes\":\"Journal Article\",\"fieldsOfStudy\":null,\"isOpenAccess\":false,\"openAccessPdf\":\"https://www.sciencedirect.com/science/article/pii/S105687272400045X/pdfft?md5=8e80ff85a7cbc3aee38144c09c6e8095&pid=1-s2.0-S105687272400045X-main.pdf\",\"citationCount\":\"0\",\"resultStr\":null,\"platform\":\"Semanticscholar\",\"paperid\":null,\"PeriodicalName\":\"Journal of diabetes and its complications\",\"FirstCategoryId\":\"3\",\"ListUrlMain\":\"https://www.sciencedirect.com/science/article/pii/S105687272400045X\",\"RegionNum\":3,\"RegionCategory\":\"医学\",\"ArticlePicture\":[],\"TitleCN\":null,\"AbstractTextCN\":null,\"PMCID\":null,\"EPubDate\":\"\",\"PubModel\":\"\",\"JCR\":\"Q3\",\"JCRName\":\"ENDOCRINOLOGY & METABOLISM\",\"Score\":null,\"Total\":0}","platform":"Semanticscholar","paperid":null,"PeriodicalName":"Journal of diabetes and its complications","FirstCategoryId":"3","ListUrlMain":"https://www.sciencedirect.com/science/article/pii/S105687272400045X","RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q3","JCRName":"ENDOCRINOLOGY & METABOLISM","Score":null,"Total":0}
Multidisciplinary management of diabetic foot infection associated with improved 8-year overall survival
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.
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.
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