Risk factors for mortality among patients undergoing major amputations due to infected diabetic feet

Abstract Background Foot ulcers in patients with diabetes are a major public health problem and are often associated with lower limbs amputation and mortality in this population. Objectives To investigate the risk factors associated with mortality in patients with infected diabetic foot ulcers and major lower limb amputations. Methods This was an observational, retrospective, case-control study with a sample of 78 patients with infected diabetic foot ulcers who had major lower limb amputations at a Vascular Surgery Service at a university hospital. Results The mean age of the study sample was 63.8 ± 10.5 years, 54 (69.2%) were male, mean serum creatinine was 2.49 ± 2.4 mg/dL and mean serum hemoglobin was 7.36 ± 1.7 g/dL. There was a 47.4% rate of readmissions to the same hospital. Transtibial amputation was performed in 59.0%; and transfemoral amputation in 39.7% of the sample. In this sample, 87.2% had a positive culture, predominantly (68.0%) monomicrobial and nosocomial infection of ulcers was observed in 30.8%. The most common bacterial genera were Acinetobacter spp. (24.4%), Morganella spp. (24.4%) and Proteus spp. (23.1%). No bacterial genus was identified as a predictor of death. Creatinine level ≥ 1.3 mg/dL (OR 17.8; IC 2.1-150) and transfemoral amputation (OR 4.5; IC: 1.3-15.7) were associated with death. Conclusions Serum creatinine levels ≥ 1.3 mg/dL and transfemoral amputation were risk factors for death.

【摘要 背景】糖尿病足溃疡（diabetic foot ulcers）是糖尿病患者群体中的重大公共卫生问题，该人群常伴随下肢截肢与死亡风险。
【目的】探究感染性糖尿病足溃疡（infected diabetic foot ulcers）合并下肢大截肢（major lower limb amputations）患者死亡的相关危险因素。
【方法】本研究为观察性回顾性病例对照研究（observational retrospective case-control study），纳入某大学附属医院血管外科（Vascular Surgery Service）收治的78例感染性糖尿病足溃疡合并下肢大截肢患者作为研究样本。
【结果】研究样本的平均年龄为63.8±10.5岁，其中男性54例（占比69.2%）；平均血清肌酐（serum creatinine）水平为2.49±2.4 mg/dL，平均血清血红蛋白（serum hemoglobin）水平为7.36±1.7 g/dL。患者的本院再入院率为47.4%。本样本中，经胫骨截肢术（transtibial amputation）占比59.0%，经股骨截肢术（transfemoral amputation）占比39.7%。87.2%的患者病原学培养呈阳性，其中68.0%为单菌感染（monomicrobial infection），30.8%的溃疡感染为医院获得性感染（nosocomial infection）。最常见的细菌属依次为不动杆菌属（Acinetobacter spp.，24.4%）、摩根菌属（Morganella spp.，24.4%）与变形杆菌属（Proteus spp.，23.1%）。未发现可作为死亡预测因子的细菌属。血清肌酐水平≥1.3 mg/dL（OR=17.8，IC=2.1~150）与经股骨截肢术（OR=4.5，IC=1.3~15.7）均与患者死亡显著相关。
【结论】血清肌酐水平≥1.3 mg/dL与经股骨截肢术均为感染性糖尿病足溃疡合并下肢大截肢患者死亡的危险因素。