Long-term prognosis of diabetic foot patients and their limbs: amputation and death over the course of a decade.
Long-term prognosis of diabetic foot patients and their limbs: amputation and death over the course of a decade.
复制标题
DOI：
10.2337/dc12-0200
复制
发表时间：
2012-10
期刊：
影响因子：
16.2
通讯作者：
Armstrong DG
中科院分区：
文献类型：
--
作者：
Morbach S;Furchert H;Gröblinghoff U;Hoffmeier H;Kersten K;Klauke GT;Klemp U;Roden T;Icks A;Haastert B;Rümenapf G;Abbas ZG;Bharara M;Armstrong DG
糖尿病足溃疡（DFU）患者的患者和肢体存活率缺乏长期数据。因此，我们研究的目的是前瞻性地调查DFU患者在超过10年的随访期内的肢体和人身生存。本研究纳入了1998年6月至1999年12月期间在一家糖尿病中心连续就诊的247例DFU患者，这些患者既往无大截肢，随访至2011年5月。患者平均年龄为68.8 ± 10.9岁，58.7%为男性，55.5%患有外周动脉疾病（PAD）。采用Kaplan-Meier曲线和考克斯多元回归分析至首次大截肢和至死亡的时间。随访期间，38例患者（15.4%）发生首次大截肢。除1例患者外，所有这些患者在入选研究时均有PAD证据，51.4%的患者有重度PAD [踝臂压力指数≤0.4]）。年龄（每年的风险比[HR]，1.05 [95% CI，1.01-1.10]）、正在接受透析（3.51 [1.02-12.07]）和PAD（35.34 [4.81-259.79]）是首次大截肢的重要预测因素。第1、3、5和10年的累积死亡率分别为15.4、33.1、45.8和70.4%。死亡的显著预测因素为年龄（HR/年，1.08 [95% CI，1.06-1.10]）、男性（[1.18-2.32]）、慢性肾功能不全（1.83 [1.25-2.66]）、透析（6.43 [3.14-13.16]）和PAD（1.44 [1.05-1.98]）。尽管在这一现代系列的糖尿病足患者中长期保肢是有利的，但长期生存率仍然很差，特别是在PAD或肾功能不全患者中。
There is a dearth of long-term data regarding patient and limb survival in patients with diabetic foot ulcers (DFUs). The purpose of our study was therefore to prospectively investigate the limb and person survival of DFU patients during a follow-up period of more than 10 years. Two hundred forty-seven patients with DFUs and without previous major amputation consecutively presenting to a single diabetes center between June 1998 and December 1999 were included in this study and followed up until May 2011. Mean patient age was 68.8 ± 10.9 years, 58.7% were male, and 55.5% had peripheral arterial disease (PAD). Times to first major amputation and to death were analyzed with Kaplan-Meier curves and Cox multiple regression. A first major amputation occurred in 38 patients (15.4%) during follow-up. All but one of these patients had evidence of PAD at inclusion in the study, and 51.4% had severe PAD [ankle-brachial pressure index ≤0.4]). Age (hazard ratio [HR] per year, 1.05 [95% CI, 1.01–1.10]), being on dialysis (3.51 [1.02–12.07]), and PAD (35.34 [4.81–259.79]) were significant predictors for first major amputation. Cumulative mortalities at years 1, 3, 5, and 10 were 15.4, 33.1, 45.8, and 70.4%, respectively. Significant predictors for death were age (HR per year, 1.08 [95% CI, 1.06–1.10]), male sex ([1.18–2.32]), chronic renal insufficiency (1.83 [1.25–2.66]), dialysis (6.43 [3.14–13.16]), and PAD (1.44 [1.05–1.98]). Although long-term limb salvage in this modern series of diabetic foot patients is favorable, long-term survival remains poor, especially among patients with PAD or renal insufficiency.
登录
查看更多内容
影响因子：
8.2
作者：
Gershater, M. A.;Londahl, M.;Apelqvist, J.
通讯作者：
Apelqvist, J.
影响因子：
3
作者：
Winkley, Kirsty;Stahl, Daniel;Ismall, Khalida
通讯作者：
Ismall, Khalida
影响因子：
16.2
作者：
Faglia, E;Favales, F;Morabito, A
通讯作者：
Morabito, A
影响因子：
1.6
作者：
Chammas, NK;Hill, RLR;Edmonds, ME
通讯作者：
Edmonds, ME
影响因子：
16.2
作者：
Icks, Andrea;Scheer, Marsel;Hoffmann, Falk
通讯作者：
Hoffmann, Falk