title: Risk factors for lower extremity amputation in diabetic foot disease categorized by Wagner classification.
abstract: OBJECTIVE
  To elucidate the risk factors for lower extremity amputation (LEA) in patients of diabetic foot disease with different Wagner gradings.
  
  
  METHODS
  This study was conducted in a multidisciplinary diabetic foot care center. Demographic characteristics, laboratory data, disease history, ankle brachial pressure index (ABI) and Wagner classification were considered as independent variables to predict the therapeutic outcome (major LEA, minor LEA, and non-amputation). Risk factors for LEA in different Wagner grades were further analyzed. Multivariate stepwise ordinal logistic regression was performed.
  
  
  RESULTS
  Of 789 study subjects, 19.9% received major LEA and 22.9% received minor LEA. Higher Wagner grade, lower ABI, serum albumin and hemoglobin, and elevated white blood cell (WBC) count were significantly associated with an increased risk of LEA. When stratified by Wagner classification, most of the above predictors and estimated glomerular filtration (eGFR) were detected only in grade 3. While in grades 2 and 4, WBC count was identified as primary predictor positively associated with an increased risk of LEA.
  
  
  CONCLUSIONS
  Wagner classification remarkably influenced the potential risk factors for LEA, showing different predictors in different grades. The traditionally recognized predictors for diabetic foot amputation such as lower ABI, albumin or eGFR were almost exclusively found in patients with Wagner grade 3.
authors: Division of Endocrinology and Metabolism, Department of Internal Medicine, Chang Gung Memorial Hospital, Chang Gung University, 5 Fusing St., Gueishan Township, Taoyuan County 333, Taiwan, ROC.
authors: Jui-Hung
authors: JH
authors: Sun
authors: Jir-Shiong
authors: JS
authors: Tsai
authors: Chung-Huei
authors: CH
authors: Huang
authors: Chia-Hung
authors: CH
authors: Lin
authors: Hui-Mei
authors: HM
authors: Yang
authors: Yi-Sheng
authors: YS
authors: Chan
authors: Sheng-Hwu
authors: SH
authors: Hsieh
authors: Brend Ray-Sea
authors: BR
authors: Hsu
authors: Yu-Yao
authors: YY
authors: Huang
mesh_terms: D000368:Aged; D000671:Amputation, Surgical; D017719:Diabetic Foot / Q000145:classification / Q000601:surgery*; D005260:Female; D006801:Humans; D035002:Lower Extremity / Q000601:surgery; D008297:Male; D008875:Middle Aged; D011237:Predictive Value of Tests; D011379:Prognosis; D012307:Risk Factors