title: Health-related quality of life predicts major amputation and death, but not healing, in people with diabetes presenting with foot ulcers: the Eurodiale study.
abstract: OBJECTIVE
  Low health-related quality of life (HRQoL) has been consistently reported to be associated with poor prognosis for a variety of health outcomes in various settings. We aimed to evaluate whether HRQoL in patients presenting with new diabetic foot ulcers (DFUs) has prognostic significance for ulcer healing, major amputation, and death.
  
  
  METHODS
  We followed 1,088 patients with new DFUs presenting for treatment at one of the 14 centers in 10 European countries participating in the Eurodiale (European Study Group on Diabetes and the Lower Extremity) study, prospectively until healing (76.9%), major amputation (4.6%), or death (6.4%) up to a maximum of 1 year. At baseline, patient and ulcer characteristics were recorded as well as EQ-5D, a standardized instrument consisting of five domains and a visual analog scale for use as a measure of HRQoL. The prognostic influence of the EQ-5D domains was evaluated in multivariable Cox regression analyses on the time-to-event data, adjusting for baseline clinical characteristics of the ulcer and comorbidities.
  
  
  RESULTS
  While predictive effects of HRQoL, adjusted for possible confounders, were absent for healing, decreased HRQoL, especially in the physical domains, was statistically significant for major amputation (mobility, self-care, usual activities) and death (self-care, usual activities, pain/discomfort).
  
  
  CONCLUSIONS
  Low HRQoL appears to be predictive for major amputation and death, but high HRQoL does not increase healing. Future studies into the influence of HRQoL on ulcer outcome are important in attempts to decrease treatment failure and mortality.
authors.affiliation: Corresponding author: Volkert Siersma, siersma@sund.ku.dk.
authors.forename: Volkert
authors.initials: V
authors.lastname: Siersma
authors.forename: Hanne
authors.initials: H
authors.lastname: Thorsen
authors.forename: Per E
authors.initials: PE
authors.lastname: Holstein
authors.forename: Marleen
authors.initials: M
authors.lastname: Kars
authors.forename: Jan
authors.initials: J
authors.lastname: Apelqvist
authors.forename: Edward B
authors.initials: EB
authors.lastname: Jude
authors.forename: Alberto
authors.initials: A
authors.lastname: Piaggesi
authors.forename: Karel
authors.initials: K
authors.lastname: Bakker
authors.forename: Michael
authors.initials: M
authors.lastname: Edmonds
authors.forename: Alexandra
authors.initials: A
authors.lastname: Jirkovská
authors.forename: Didac
authors.initials: D
authors.lastname: Mauricio
authors.forename: Gunnel
authors.initials: G
authors.lastname: Ragnarson Tennvall
authors.forename: Heinrich
authors.initials: H
authors.lastname: Reike
authors.forename: Maximilian
authors.initials: M
authors.lastname: Spraul
authors.forename: Luigi
authors.initials: L
authors.lastname: Uccioli
authors.forename: Vilma
authors.initials: V
authors.lastname: Urbancic
authors.forename: Kristien
authors.initials: K
authors.lastname: van Acker
authors.forename: Jeff
authors.initials: J
authors.lastname: van Baal
authors.forename: Nicolaas C
authors.initials: NC
authors.lastname: Schaper
mesh_terms: D000223:Adaptation, Psychological; D000368:Aged; D000671:Amputation, Surgical / Q000401:mortality* / Q000523:psychology; D001008:Anxiety Disorders / Q000401:mortality; D003866:Depressive Disorder / Q000401:mortality; D017719:Diabetic Foot / Q000401:mortality* / Q000503:physiopathology / Q000523:psychology; D005060:Europe / Q000453:epidemiology; D005260:Female; D006304:Health Status; D006801:Humans; D008297:Male; D010149:Postoperative Pain / Q000401:mortality / Q000523:psychology; D011379:Prognosis; D011788:Quality of Life; D012648:Self Care; D014945:Wound Healing / Q000502:physiology