Time-Dependent Impact of Diabetes on Mortality in Patients After Major Lower Extremity Amputation Survival in a population-based 5-year cohort in Germany
Time-Dependent Impact of Diabetes on Mortality in Patients After Major Lower Extremity Amputation Survival in a population-based 5-year cohort in Germany
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DOI：
10.2337/dc10-2341
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发表时间：
2011-06-01
期刊：
影响因子：
16.2
通讯作者：
Hoffmann, Falk
中科院分区：
文献类型：
--
作者：
Icks, Andrea;Scheer, Marsel;Hoffmann, Falk
目的：评估糖尿病对首次下肢大截肢（LEA）患者死亡率的影响。研究设计和方法：使用全国法定健康保险的索赔数据，我们评估了自2005年以来444例首次严重LEA患者（71.8%为男性，平均年龄69.1岁，58.3%为糖尿病患者，43%为膝关节以上截肢）至2009年的所有死亡病例。使用Cox回归，我们估计了时间依赖的风险比来比较有糖尿病和没有糖尿病的患者。结果：糖尿病患者5年累计死亡率为68%，非糖尿病患者为59%。在第一个疗程中，糖尿病患者的死亡率比非糖尿病患者低。2 ~ 3年后，糖尿病风险增加，产生交叉生存曲线（糖尿病时间依赖性，P = 0.003）。年龄和性别调整后的糖尿病风险比如下：0-30天：0.50 [95% CI 0.31-0.84]；31-60天：0.60 [0.25-1.41]；61天至6个月：0.75 [0.38-1.48]；>6-12个月：1.27 [0.63-2.53]；>12-24个月：1.65 [0.88-3.08]；>24-36个月：2.02 [0.80-5.09]；36-60个月：1.91[0.70-5.21]。这种模式在两性中都是相似的。在全模型中，死亡率的显著危险因素为年龄（1.05;1.03-1.06）、膝以上截肢（1.50;1.16-1.94）和处方药物数量的四分位数类别3或4（1.64;1.12-2.40和1.76;1.20-2.59）。进一步调整合并症并没有改变结果。结论：在这项以人群为基础的研究中，我们发现首次主要LEA后糖尿病的死亡率风险具有时间依赖性，这可能部分是由于糖尿病患者更健康的生活方式或糖尿病患者获得特定治疗结构的结果。
OBJECTIVE-To estimate the impact of diabetes on mortality in patients after first major lower extremity amputation (LEA).RESEARCH DESIGN AND METHODS-Using claims data of a nationwide statutory health insurance, we assessed all deaths in a cohort of all 444 patients with a first major LEA since 2005 (71.8% male; mean age 69.1 years; 58.3% diabetic; 43% with amputation above the knee) up to 2009. Using Cox regression, we estimated the time-dependent hazard ratios to compare patients with and without diabetes.RESULTS-The cumulative 5-year mortality was 68% in diabetic and 59% in nondiabetic individuals. In the first course, mortality was lower in diabetic compared with nondiabetic patients. Later, the diabetes risk increased yielding crossed survival curves after 2 to 3 years (time dependency of diabetes; P = 0.003). Age- and sex-adjusted hazard ratios for diabetes were as follows: 0-30 days: 0.50 [95% CI 0.31-0.84]; 31-60 days: 0.60 [0.25-1.41]; 61 days to 6 months: 0.75 [0.38-1.48]; >6-12 months: 1.27 [0.63-2.53]; >12-24 months: 1.65 [0.88-3.08]; >24-36 months: 2.02 [0.80-5.09]; and >36-60 months: 1.91 [0.70-5.21]. The pattern was similar in both sexes. In the full model, significant risk factors for mortality were age (1.05; 1.03-1.06), amputation above the knee (1.50; 1.16-1.94), and quartile category 3 or 4 of the number of prescribed medications (1.64; 1.12-2.40 and 1.76; 1.20-2.59). Further adjustment for comorbidity did not alter the results.CONCLUSIONS-In this population-based study, we found a time-dependent mortality risk of diabetes following first major LEA, which may be in part a result of a healthier lifestyle in diabetic patients or the access to specific treatment structures in diabetic individuals.