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.

【背景】糖尿病患者足部溃疡是一项重大公共卫生问题，该群体常因此面临下肢截肢与死亡风险。
【目的】探究感染性糖尿病足溃疡合并下肢大截肢患者的死亡相关危险因素。
【方法】本研究为回顾性观察性病例对照研究，纳入某大学医院血管外科收治的78例感染性糖尿病足溃疡且接受下肢大截肢术的患者作为研究对象。
【结果】本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%）；平均血清肌酐水平为2.49±2.4 mg/dL，平均血清血红蛋白水平为7.36±1.7 g/dL。该群体的本院再入院率为47.4%。样本中59.0%接受经胫骨截肢术，39.7%接受经股骨截肢术。本样本中87.2%的患者细菌培养呈阳性，其中以单一菌感染为主（占68.0%）；30.8%的溃疡为医院获得性感染。最常见的细菌菌属为不动杆菌属（Acinetobacter spp.，24.4%）、摩根菌属（Morganella spp.，24.4%）以及变形杆菌属（Proteus spp.，23.1%）。未发现某一细菌属可作为死亡预测因子。血清肌酐水平≥1.3 mg/dL（比值比OR=17.8，置信区间IC=2.1~150）与经股骨截肢术（OR=4.5，IC=1.3~15.7）均与患者死亡相关。
【结论】血清肌酐水平≥1.3 mg/dL与经股骨截肢术均为患者死亡的危险因素。