Diabetic foot ulcer severity predicts mortality among veterans with type 2 diabetes.
Diabetic foot ulcer severity predicts mortality among veterans with type 2 diabetes.
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DOI：
10.1016/j.jdiacomp.2016.11.020
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发表时间：
2017-03
影响因子：
3
通讯作者：
Crnich C
中科院分区：
文献类型：
--
作者：
Brennan MB;Hess TM;Bartle B;Cooper JM;Kang J;Huang ES;Smith M;Sohn MW;Crnich C
糖尿病足溃疡与死亡风险增加有关。我们评估了临床表现时溃疡严重程度是否能预测死亡率。对2006年1月1日至2010年9月1日期间发生糖尿病足部溃疡的国家2型糖尿病退伍军人队列中的患者进行跟踪调查，直到2012年1月1日死亡或研究结束。溃疡的特征是早期表现为骨髓炎或坏疽。COX比例风险回归确定了死亡的独立预测因素，控制了合并症、实验室参数和医疗保健利用。队列中包括66,323名退伍军人，平均随访27.7个月：1、2和5年生存率分别为80.80%、69.01%和28.64%。与早期溃疡相比，坏疽与死亡风险增加相关(HR1.70，95%CI1.57-1.83，p<；0.001)。这种影响的程度大于诊断的血管疾病，即冠状动脉疾病、外周动脉疾病或中风。与冠状动脉疾病、外周动脉疾病或中风相比，最初的糖尿病足溃疡严重程度是预测后续死亡率的更重要的指标。未被识别或低估的血管疾病和/或坏疽继发的败血症应作为可能的原因进行探讨。
Diabetic foot ulcers are associated with an increased risk of death. We evaluated whether ulcer severity at presentation predicts mortality. Patients from a national, retrospective, cohort of veterans with type 2 diabetes who developed incident diabetic foot ulcers between January 1, 2006 and September 1, 2010, were followed until death or the end of the study period, January 1, 2012. Ulcers were characterized as early stage, osteomyelitis, or gangrene at presentation. Cox proportional hazard regression identified independent predictors of death, controlling for comorbidities, laboratory parameters, and healthcare utilization. 66,323 veterans were included in the cohort and followed for a mean of 27.7 months: 1-, 2-, and 5-year survival rates were 80.80%, 69.01% and 28.64%, respectively. Compared to early stage ulcers, gangrene was associated with an increased risk of mortality (HR 1.70, 95% CI 1.57 – 1.83, p<0.001). The magnitude of this effect was greater than diagnosed vascular disease, i.e., coronary artery disease, peripheral arterial disease, or stroke. Initial diabetic foot ulcer severity is a more significant predictor of subsequent mortality than coronary artery disease, peripheral arterial disease, or stroke. Unrecognized or under-estimated vascular disease and/or sepsis secondary to gangrene should be explored as possible causal explanations.