title: Predictive model of short-term amputation during hospitalization of patients due to acute diabetic foot infections.
abstract: BACKGROUND
  Factors predicting short-term amputation during hospital treatment of patients admitted for acute diabetic foot infections are of interest for clinicians managing the acute episode.
  
  
  METHODS
  A retrospective clinical records analysis of 78 consecutive patients hospitalized for acute diabetic foot infections was performed to identify predictive factors for short-term amputation by comparing the data of patients who ultimately required amputation and those who did not. Clinical/epidemiological, laboratory, imaging, and treatment variables were comparatively analyzed. A logistic regression model was performed, with amputation as the dependent variable and factors showing significant differences in the bivariate analysis as independent variables. A prediction score was calculated (and validated by ROC curve analysis) using beta coefficients for significant variables in the regression analysis to predict amputation.
  
  
  RESULTS
  Of the 78 patients (70.5% with peripheral vasculopathy) included, 26 ultimately required amputation. In the bivariate analysis, white blood cell count, previous homolateral lesions, odor, lesion depth, sedimentation rate, Wagner ulcer grade, and arterial obstruction on Doppler study were significantly higher in patients ending in amputation. In the multivariate analysis, the risk of amputation was increased only by Wagner grade 4 or 5 (20-fold higher), obstruction (12.5-fold higher), and elevated sedimentation rate (6% higher per unit). Logistic regression predicted outcome in 76.9% of patients who underwent amputation and 92.3% of those who did not.
  
  
  CONCLUSIONS
  The score calculated using beta coefficients for significant variables in the regression model (Wagner grades 4 and 5, obstruction on Doppler, and elevated sedimentation rate for the clinical, imaging, and laboratory data, respectively) correctly predicted amputation during hospital management of acute diabetic foot infections.
authors.affiliation: Infectious Diseases Department, Hospital Central de la Defensa Gómez Ulla, Madrid, Spain. josebarberan@teleline.es
authors.forename: José
authors.initials: J
authors.lastname: Barberán
authors.forename: Juan-José
authors.initials: JJ
authors.lastname: Granizo
authors.forename: Lorenzo
authors.initials: L
authors.lastname: Aguilar
authors.forename: Rafael
authors.initials: R
authors.lastname: Alguacil
authors.forename: Felipe
authors.initials: F
authors.lastname: Sainz
authors.forename: Maria-Antonia
authors.initials: MA
authors.lastname: Menéndez
authors.forename: Maria-José
authors.initials: MJ
authors.lastname: Giménez
authors.forename: David
authors.initials: D
authors.lastname: Martínez
authors.forename: José
authors.initials: J
authors.lastname: Prieto
mesh_terms: D000208:Acute Disease; D000368:Aged; D000369:Aged, 80 and over; D000671:Amputation, Surgical / Q000706:statistics & numerical data; D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D001424:Bacterial Infections / Q000188:drug therapy / Q000209:etiology / Q000601:surgery*; D001799:Blood Sedimentation; D003131:Combined Modality Therapy; D015897:Comorbidity; D003925:Diabetic Angiopathies / Q000150:complications; D017719:Diabetic Foot / Q000150:complications / Q000000981:diagnostic imaging / Q000601:surgery*; D005260:Female; D006760:Hospitalization; D006801:Humans; D008297:Male; D008875:Middle Aged; D008962:Models, Theoretical; D011379:Prognosis; D012372:ROC Curve; D011859:Radiography; D012189:Retrospective Studies; D012307:Risk Factors; D012720:Severity of Illness Index; D014463:Ultrasonography
chemical_list: D000900:Anti-Bacterial Agents