Prediction of outcome in individuals with diabetic foot ulcers: focus on the differences between individuals with and without peripheral arterial disease. The EURODIALE Study.
OBJECTIVE
Outcome data on individuals with diabetic foot ulcers are scarce, especially in those with peripheral arterial disease (PAD). We therefore examined the clinical characteristics that best predict poor outcome in a large population of diabetic foot ulcer patients and examined whether such predictors differ between patients with and without PAD.


METHODS
Analyses were conducted within the EURODIALE Study, a prospective cohort study of 1,088 diabetic foot ulcer patients across 14 centres in Europe. Multiple logistic regression modelling was used to identify independent predictors of outcome (i.e. non-healing of the foot ulcer).


RESULTS
After 1 year of follow-up, 23% of the patients had not healed. Independent baseline predictors of non-healing in the whole study population were older age, male sex, heart failure, the inability to stand or walk without help, end-stage renal disease, larger ulcer size, peripheral neuropathy and PAD. When analyses were performed according to PAD status, infection emerged as a specific predictor of non-healing in PAD patients only.


CONCLUSIONS
Predictors of healing differ between patients with and without PAD, suggesting that diabetic foot ulcers with or without concomitant PAD should be defined as two separate disease states. The observed negative impact of infection on healing that was confined to patients with PAD needs further investigation.
Prompers
L
L
Division of Endocrinology, Department of Internal Medicine, University Hospital Maastricht, P. Debeyelaan 25, P.O. Box 5800, 6202 AZ, Maastricht, the Netherlands. Leonne.Prompers@intmed.unimaas.nl
Schaper
N
N
Apelqvist
J
J
Edmonds
M
M
Jude
E
E
Mauricio
D
D
Uccioli
L
L
Urbancic
V
V
Bakker
K
K
Holstein
P
P
Jirkovska
A
A
Piaggesi
A
A
Ragnarson-Tennvall
G
G
Reike
H
H
Spraul
M
M
Van Acker
K
K
Van Baal
J
J
Van Merode
F
F
Ferreira
I
I
Huijberts
M
M
D017668:Age of Onset; D000368:Aged; D003925:Diabetic Angiopathies / Q000150:complications*; D017719:Diabetic Foot / Q000150:complications / Q000628:therapy*; D005260:Female; D016523:Foot Ulcer / Q000150:complications / Q000473:pathology / Q000628:therapy*; D006801:Humans; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D011237:Predictive Value of Tests; D016896:Treatment Outcome; D014945:Wound Healing