Predictive model of short-term amputation during hospitalization of patients due to acute diabetic foot infections.
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.
Barberán
José
J
Infectious Diseases Department, Hospital Central de la Defensa Gómez Ulla, Madrid, Spain. josebarberan@teleline.es
Granizo
Juan-José
JJ
Aguilar
Lorenzo
L
Alguacil
Rafael
R
Sainz
Felipe
F
Menéndez
Maria-Antonia
MA
Giménez
Maria-José
MJ
Martínez
David
D
Prieto
José
J
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
D000900:Anti-Bacterial Agents