Risk factors associated with adverse outcomes in a population-based prospective cohort study of people with their first diabetic foot ulcer
Risk factors associated with adverse outcomes in a population-based prospective cohort study of people with their first diabetic foot ulcer
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DOI：
10.1016/j.jdiacomp.2007.09.004
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发表时间：
2007-11-01
影响因子：
3
通讯作者：
Ismall, Khalida
中科院分区：
文献类型：
--
作者：
Winkley, Kirsty;Stahl, Daniel;Ismall, Khalida
目的/假设：本研究的目的是确定哪些基于临床的糖尿病和足部状态基线测量指标与首次出现足部溃疡的糖尿病患者 18 个月后的不良后果相关。对象和方法：这是一项基于人群的前瞻性队列研究，对象是首次出现足部溃疡的 I 型和 2 型糖尿病成人（不包括严重缺血、踝臂压力指数 < 0.5 的患者）。主要解释变量是年龄、性别、吸烟状况、溃疡部位（背侧或足底）、溃疡的大小和严重程度、神经病变的严重程度、缺血、糖化血红蛋白、微血管和大血管并发症的存在以及抑郁。记录的主要结局是死亡、截肢和溃疡复发，以及每种结局发生所需的时间。结果：招募了253人。 18 个月时，有 40 例死亡（15.8%）、36 例截肢（15.5%）和 99 例复发（43.2%）。我们的主要发现是年龄较大[风险比 (HR) 1.07，95% CI 1.04-1.11]、糖化血红蛋白较低（HR 0.73，95% Cl 0.56-0.96）、中度缺血（HR 2.74，95% CI 1.46-5.14）和抑郁症（HR 2.51，95% Cl 1.46-5.14） 1.33-4.73）相关联 与死亡率。溃疡严重程度是与截肢显着相关的唯一解释因素（HR 3.18，95% Cl 1.53-6.59）。微血管并发症是与复发性溃疡相关的唯一解释因素（HR 3.34，95% CI 1.17-9.56）。结论/解释：常用的初级和二级护理临床措施可以为首次出现糖尿病足溃疡后不良后果的风险评估工具提供基础。 (c) 2007 Elsevier Inc. 保留所有权利。
Aims/Hypothesis: The aim of this study was to determine which clinic-based measures of diabetes and foot status at baseline were associated with adverse outcomes 18 months later in people with diabetes presenting with their first foot ulcer. Subjects and Methods: This was a prospective population-based cohort study of adults with type I and type 2 diabetes mellitus presenting with their first foot ulcer (excluding those with se,vere ischaemia, ankle brachial pressure index < 0.5). The main explanatory variables were age, sex, smoking status, ulcer site (dorsal or plantar), size and severity of ulcer, severity of neuropathy, ischaemia, glycosylated haemoglobin, presence of micro- and macrovascular complications, and depression. The main outcomes recorded were death, amputation and recurrence of ulceration, and the time taken for each outcome to occur. Results: Two hundred fifty-three people were recruited. There were 40 deaths (15.8%), 36 amputations (15.5%), and 99 recurrences (43.2%) at 18 months. Our main findings were that being older [hazard ratio (HR) 1.07, 95% CI 1.04-1.11], having lower glycosylated haemoglobin (HR 0.73, 95% Cl 0.56-0.96), moderate ischaemia (HR 2.74, 95% Cl 1.46-5.14), and depression (HR 2.51, 95% Cl 1.33-4.73) were associated with mortality. Ulcer severity was the only explanatory factor significantly associated with amputation (HR 3.18, 95% Cl 1.53-6.59). Microvascular complications were the only explanatory factor associated with recurrent ulceration (HR 3.34, 95% CI 1.17-9.56). Conclusions/Interpretation: Commonly used primary and secondary care clinic-based measures could provide the basis for a risk assessment tool for adverse outcomes following first presentation of diabetic foot ulcers. (c) 2007 Elsevier Inc. All rights reserved.