Risk factors for lower extremity amputation in patients with diabetic foot ulcers: a hospital-based case-control study.
Risk factors for lower extremity amputation in patients with diabetic foot ulcers: a hospital-based case-control study.
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DOI：
10.3402/dfa.v6.29629
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发表时间：
2015
影响因子：
--
通讯作者：
Minuljo TT
中科院分区：
文献类型：
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作者：
Pemayun TG;Naibaho RM;Novitasari D;Amin N;Minuljo TT
糖尿病足溃疡（DFU）可能会导致严重的发病率和下肢截肢（莱亚），由于糖尿病足的问题，可以更经常发生相比，一般人群。本研究的目的是使用流行病学设计来确定和量化住院DFU患者随后截肢的风险因素。我们对47例有莱亚的DFU患者和47例无莱亚的对照DFU患者进行了一项以医院为基础的病例对照研究。对照受试者与病例在年龄（±5岁）、性别和营养状况方面匹配，比例为1：1。本研究于2012年1月至2014年12月在Dr. Kariadi General Hospital塞马朗进行。使用简短的结构图从临床记录中收集患者的人口统计学数据和所有风险因素相关信息。以莱亚作为结果变量，通过logistic回归计算比值比（OR）和95%置信区间（CI）。单因素和逐步Logistic回归分析用于评估与莱亚相关的选定危险因素的独立影响。数据分析采用SPSS 21。有47个病例对照对，均诊断为2型糖尿病。7个潜在的自变量显示了影响的前景，后者定义为单变量分析时p≤0.15。多变量logistic回归确定HbA 1c水平≥8%（OR 20.47，95% CI 3.12-134.31; p=0.002），存在外周动脉疾病（PAD）（OR 12.97，95% CI 3.44-48.88; p<0.001），高甘油三酯血症（OR 5.58，95% CI 1.74-17.91; p=0.004）和高血压（OR 3.67，95% CI 1.14-11.79; p=0.028）作为与DFU中后续莱亚相关的独立风险因素。确定了莱亚的几个风险因素。我们发现HbA 1c ≥ 8%、PAD、高脂血症和高血压在本研究中被认为是莱亚的预测因素。良好的血糖控制，积极研究PAD，以及管理合并症，如高血糖症和高血压，被认为是降低截肢风险的重要因素。
Diabetic foot ulcers (DFU) may cause significant morbidity and lower extremity amputation (LEA) due to diabetic foot problems can occur more often compared to the general population. The purpose of the present study was to use an epidemiological design to determine and to quantify the risk factors of subsequent amputation in hospitalized DFU patients. We performed a hospital-based, case–control study of 47 DFU patients with LEA and 47 control DFU patients without LEA. The control subjects were matched to cases in respect to age (±5 years), sex, and nutritional status, with ratio of 1:1. This study was conducted in Dr. Kariadi General Hospital Semarang between January 2012 and December 2014. Patients’ demographical data and all risk factors-related information were collected from clinical records using a short structural chart. Using LEA as the outcome variable, we calculated odds ratios (ORs) and 95% confidence intervals (CIs) by logistic regression. Univariate and stepwise logistic regression analyses were used to assess the independent effect of selected risk factors associated with LEA. The data were analyzed in SPSS version 21. There were 47 case–control pairs, all of which were diagnosed with type 2 diabetes mellitus. Seven potential independent variables show a promise of influence, the latter being defined as p≤0.15 upon univariate analysis. Multivariable logistic regression identified levels of HbA1c ≥8% (OR 20.47, 95% CI 3.12–134.31; p=0.002), presence of peripheral arterial disease (PAD) (OR 12.97, 95% CI 3.44–48.88; p<0.001), hypertriglyceridemia (OR 5.58, 95% CI 1.74–17.91; p=0.004), and hypertension (OR 3.67, 95% CI 1.14–11.79; p=0.028) as the independent risk factors associated with subsequent LEA in DFU. Several risk factors for LEA were identified. We found that HbA1c ≥8%, PAD, hypertriglyceridemia, and hypertension have been recognized as the predictors of LEA in this study. Good glycemic control, active investigation against PAD, and management of comorbidities such as hypertriglyceridemia and hypertension are considered important to reduce amputation risk.