title: Coronary artery disease as an independent predictor of survival in patients with type 2 diabetes and Charcot neuro-osteoarthropathy.
abstract: OBJECTIVE
  Charcot neuro-osteoarthropathy (CN) is a rare complication of diabetic foot syndrome associated with chronic inflammation of the foot and severe, limb-threatening musculoskeletal deformities. Aim of this study was to investigate patients with CN for comorbidities, amputations, ulcers, secondary diseases and mortality.
  
  
  METHODS
  The study was conducted at a specialized German hospital for patients with diabetes. One-hundred and eleven patients were enrolled, and their course was followed over a period of 15 years. Association of CN with comorbidity, foot ulcers, amputations and mortality was assessed. Clinical course of patients was followed using two standardized questionnaires.
  
  
  RESULTS
  Presence of CN was significantly associated with diabetic retinopathy (p = 0.047), plantar (p < 0.001), tarsal (p = 0.032) and middle-foot ulcers (p = 0.01). A significant correlation between the presence of CN and a history of amputations was seen (p = 0.022). Patients were at increased risk to suffer from subsequent amputations during follow-up when micro- and macrovascular comorbidities such as retinopathy (p = 0.01) and peripheral artery disease (p < 0.001) were present. Additionally, coronary artery disease (CHD) was identified as an independent predictor of mortality in the cohort of this study (OR 6.192, 95 % CI 1.155-33.208, p = 0.033). Median overall survival of patients with CN and CHD was significantly shorter than OS of patients without CHD (7.8 vs. 13.1 years, p = 0.0045, HR 2.8437, 95 % CI 0.9818-8.2364).
  
  
  CONCLUSIONS
  In our study, CHD was the most important factor of survival in CN patients. For optimal management of CN, adequate diagnostics and treatment of CHD according to current guidelines should be considered.
authors.affiliation: Division of Endocrinology and Diabetes, Department of Internal Medicine 1, Goethe University Hospital, Theodor-Stern-Kai 7, 60590, Frankfurt Am Main, Germany, dominik.bergis@kgu.de.
authors.forename: Dominik
authors.initials: D
authors.lastname: Bergis
authors.forename: Pia Maria
authors.initials: PM
authors.lastname: Bergis
authors.forename: Norbert
authors.initials: N
authors.lastname: Hermanns
authors.forename: Karl
authors.initials: K
authors.lastname: Zink
authors.forename: Thomas
authors.initials: T
authors.lastname: Haak
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000671:Amputation, Surgical / Q000706:statistics & numerical data; D001177:Arthropathy, Neurogenic / Q000150:complications / Q000175:diagnosis / Q000401:mortality; D003324:Coronary Artery Disease / Q000150:complications / Q000175:diagnosis* / Q000401:mortality; D003924:Diabetes Mellitus, Type 2 / Q000150:complications / Q000175:diagnosis* / Q000401:mortality; D003925:Diabetic Angiopathies / Q000175:diagnosis* / Q000401:mortality; D017719:Diabetic Foot / Q000150:complications / Q000175:diagnosis* / Q000401:mortality / Q000601:surgery; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D016019:Survival Analysis