Prognostic factors for lower extremity amputation in diabetic foot ulcer patients

Background: Infection and necrosis are common acute complications of diabetic foot ulcer (DFU). Amputation is the last resort treatment to control severe diabetic foot infection. Many risk factors for progression of infection that lead to amputation are disclosed. However, the prediction for the amputation necessity is clinically important to stratify risk and target intervention for limb salvage. Accordingly, this study investigates the predictive risk factors for amputation need in diabetic patients with foot ulcer. Methods: We retrospectively studied the medical records of the DFU patients from January to December in 2017. The patients were classifi ed as the non-amputation and amputation groups. Patient characteristics, clinical features of vasculopathy and neuropathy (ankle brachial index [ABI] and monofi lament test), and laboratory features (hemoglobin A1C [HbA1C], C-reactive protein [CRP], and white blood cell [WBC] counts) were analyzed, using the univariate and multivariate analyses. Results: Of the eligible 73 cases (age 41 to 76 years), 14 (19.2%) underwent lower limb amputation. Using the multivariate model, signifi cate risk factors included low ABI (< 0.8; adjusted odds ratio [OR] = 17.9; p = 0.003), the presence of neuropathy (adjusted OR = 5.6; p = 0.005), and HbA1C > 8.0% (adjusted OR = 4.7; p = 0.016). Conclusions: Several predictors, such as vasculopathy, neuropathy, higher HbA1C and CRP, were associated with amputation necessities in DFU patients. Of note, the vasculopathy was found to be the most important powerful. Therefore, identifi cation and correction of these predictors would improve the quality care and patient prognosis.