{"title":"糖尿病足溃疡患者截肢的危险因素分析:来自三级中心的队列研究。","authors":"Denizhan Demirkol, Şamil Aktaş, Tuncay Özcan, Xavier Tannier, Çiğdem Selçukcan Erol","doi":"10.5152/j.aott.2022.22052","DOIUrl":null,"url":null,"abstract":"<p><strong>Objective: </strong>This study aimed to analyze risk factors for amputation (overall, minor and major) in patients with diabetic foot ulcers (DFUs).</p><p><strong>Methods: </strong>407 patients with DFUs (286 male, 121 female; mean age = 60, age range = 32-92) who were managed in a tertiary care centre from 2009 to 2019 were retrospectively identified and included in the study. DFUs were categorized based on the Meggit-Wagner, PEDIS, S(AD)SAD, and University of Texas (UT) classification systems. To identify amputation risk-related factors, results of patients with DFUs who underwent amputations (minor or major) were compared to those who received other adjunctive treatments using Chi-Square, oneway analysis of variance (ANOVA) and Spearman correlation analysis.</p><p><strong>Results: </strong>The mean C-reactive protein (CRP) and White Blood Cell (WBC) values were significantly higher in patients with major or minor amputation than in those without amputation. The mean Neutrophil (PNL), Platelets (PLT), wound width, creatinine and sedimentation (ESR) values were significantly higher in patients with major amputation compared to other groups of patients. Elevated levels of Highdensity lipoprotein (HDL), Hemoglobin (HGB) and albumin were determined to be protective factors against the risk of amputation. Spearman correlation analysis revealed a positive-sided, strong-levelled, significant relation between Wagner grades and amputation status of patients.</p><p><strong>Conclusion: </strong>This study has identified specific factors for major and minor amputation risk of patients with DFUs. Especially infection markers such as CRP, WBC, ESR and PNL were higher in the amputation group. Most importantly, Meggit Wagner, one of the four different classification systems used in the DFUs, was determined to be highly associated with patients' amputation risk.</p><p><strong>Level of evidence: </strong>Level IV, Prognostic Study.</p>","PeriodicalId":7097,"journal":{"name":"Acta orthopaedica et traumatologica turcica","volume":null,"pages":null},"PeriodicalIF":1.1000,"publicationDate":"2022-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/8c/d2/aott-56-5-333.PMC9682599.pdf","citationCount":"8","resultStr":"{\"title\":\"Analysis of risk factors for amputation in patients with diabetic foot ulcers: a cohort study from a tertiary center.\",\"authors\":\"Denizhan Demirkol, Şamil Aktaş, Tuncay Özcan, Xavier Tannier, Çiğdem Selçukcan Erol\",\"doi\":\"10.5152/j.aott.2022.22052\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<p><strong>Objective: </strong>This study aimed to analyze risk factors for amputation (overall, minor and major) in patients with diabetic foot ulcers (DFUs).</p><p><strong>Methods: </strong>407 patients with DFUs (286 male, 121 female; mean age = 60, age range = 32-92) who were managed in a tertiary care centre from 2009 to 2019 were retrospectively identified and included in the study. DFUs were categorized based on the Meggit-Wagner, PEDIS, S(AD)SAD, and University of Texas (UT) classification systems. To identify amputation risk-related factors, results of patients with DFUs who underwent amputations (minor or major) were compared to those who received other adjunctive treatments using Chi-Square, oneway analysis of variance (ANOVA) and Spearman correlation analysis.</p><p><strong>Results: </strong>The mean C-reactive protein (CRP) and White Blood Cell (WBC) values were significantly higher in patients with major or minor amputation than in those without amputation. The mean Neutrophil (PNL), Platelets (PLT), wound width, creatinine and sedimentation (ESR) values were significantly higher in patients with major amputation compared to other groups of patients. Elevated levels of Highdensity lipoprotein (HDL), Hemoglobin (HGB) and albumin were determined to be protective factors against the risk of amputation. Spearman correlation analysis revealed a positive-sided, strong-levelled, significant relation between Wagner grades and amputation status of patients.</p><p><strong>Conclusion: </strong>This study has identified specific factors for major and minor amputation risk of patients with DFUs. Especially infection markers such as CRP, WBC, ESR and PNL were higher in the amputation group. 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引用次数: 8
摘要
目的:本研究旨在分析糖尿病足溃疡(DFUs)患者截肢的危险因素(总体、轻微和严重)。方法:407例DFUs患者(男性286例,女性121例;2009年至2019年在三级保健中心管理的平均年龄= 60岁,年龄范围= 32-92岁)被回顾性识别并纳入研究。根据Meggit-Wagner、PEDIS、S(AD)SAD和University of Texas (UT)分类系统对DFUs进行分类。为了确定截肢风险相关因素,采用卡方分析、单因素方差分析(ANOVA)和Spearman相关分析,将接受截肢(轻微或严重)的DFUs患者的结果与接受其他辅助治疗的患者进行比较。结果:严重或轻微截肢患者c反应蛋白(CRP)和白细胞(WBC)的平均值明显高于未截肢患者。大截肢患者的平均中性粒细胞(PNL)、血小板(PLT)、伤口宽度、肌酐和沉降(ESR)值明显高于其他组患者。高水平的高密度脂蛋白(HDL)、血红蛋白(HGB)和白蛋白被确定为防止截肢危险的保护因素。Spearman相关分析显示,Wagner评分与患者截肢状况之间存在正侧、强水平、显著的关系。结论:本研究确定了DFUs患者主要和次要截肢风险的特定因素。其中,截肢组CRP、WBC、ESR、PNL等感染指标较高。最重要的是,在DFUs中使用的四种不同分类系统之一的Meggit Wagner被确定与患者的截肢风险高度相关。证据等级:IV级,预后研究。
Analysis of risk factors for amputation in patients with diabetic foot ulcers: a cohort study from a tertiary center.
Objective: This study aimed to analyze risk factors for amputation (overall, minor and major) in patients with diabetic foot ulcers (DFUs).
Methods: 407 patients with DFUs (286 male, 121 female; mean age = 60, age range = 32-92) who were managed in a tertiary care centre from 2009 to 2019 were retrospectively identified and included in the study. DFUs were categorized based on the Meggit-Wagner, PEDIS, S(AD)SAD, and University of Texas (UT) classification systems. To identify amputation risk-related factors, results of patients with DFUs who underwent amputations (minor or major) were compared to those who received other adjunctive treatments using Chi-Square, oneway analysis of variance (ANOVA) and Spearman correlation analysis.
Results: The mean C-reactive protein (CRP) and White Blood Cell (WBC) values were significantly higher in patients with major or minor amputation than in those without amputation. The mean Neutrophil (PNL), Platelets (PLT), wound width, creatinine and sedimentation (ESR) values were significantly higher in patients with major amputation compared to other groups of patients. Elevated levels of Highdensity lipoprotein (HDL), Hemoglobin (HGB) and albumin were determined to be protective factors against the risk of amputation. Spearman correlation analysis revealed a positive-sided, strong-levelled, significant relation between Wagner grades and amputation status of patients.
Conclusion: This study has identified specific factors for major and minor amputation risk of patients with DFUs. Especially infection markers such as CRP, WBC, ESR and PNL were higher in the amputation group. Most importantly, Meggit Wagner, one of the four different classification systems used in the DFUs, was determined to be highly associated with patients' amputation risk.
期刊介绍:
Acta Orthopaedica et Traumatologica Turcica (AOTT) is an international, scientific, open access periodical published in accordance with independent, unbiased, and double-blinded peer-review principles. The journal is the official publication of the Turkish Association of Orthopaedics and Traumatology, and Turkish Society of Orthopaedics and Traumatology. It is published bimonthly in January, March, May, July, September, and November. The publication language of the journal is English.
The aim of the journal is to publish original studies of the highest scientific and clinical value in orthopedics, traumatology, and related disciplines. The scope of the journal includes but not limited to diagnostic, treatment, and prevention methods related to orthopedics and traumatology. Acta Orthopaedica et Traumatologica Turcica publishes clinical and basic research articles, case reports, personal clinical and technical notes, systematic reviews and meta-analyses and letters to the Editor. Proceedings of scientific meetings are also considered for publication.
The target audience of the journal includes healthcare professionals, physicians, and researchers who are interested or working in orthopedics and traumatology field, and related disciplines.