The major predictors of amputation and length of stay in diabetic patients with acute foot ulceration.
BACKGROUND
Diabetic foot infections are associated with substantial morbidity and mortality. Prediction of diabetic foot ulcer outcome may be helpful for optimizing management strategy. This study aimed to determine the major predictors of amputation and length of stay in diabetic patients with acute foot ulceration.


METHODS
A total of 55 type 2 diabetic patients with diabetic foot infection were enrolled. The patients were evaluated according to the Infectious Diseases Society of America and International Working Group on the Diabetic Foot criteria and also the Wagner's classification. Blood samples were taken at the start of hospitalization for the measurement of glucose, hemoglobin A1C (HbA1C), white blood cells (WBC), C-reactive protein (CRP), and erythrocyte sedimentation rate (ESR). Length of stay in hospital was recorded.


RESULTS
WBC and CRP were significantly higher in lower-extremity amputation (LEA) group (p = 0.001 and p = 0.008, respectively); also, ESR was higher in this group, but there was no statistical significance. Wagner grade and infection severity were significantly higher in the LEA group as compared with the non-LEA group (both p values < 0.001). Glycemic control parameters (i.e., HbA1C, plasma glucose) were not different in LEA and non-LEA groups. In correlation analyses, amputation rate was negatively correlated (r = - 0.512, p < 0.001) with length of stay. WBC, ESR, CRP, Wagner grade, and severity of infection showed positive correlation with length of stay (r = 0.493, p < 0.001; r = 0.271, p = 0.045; r = 0.299, p = 0.027; r = 0.434, p = 0.001; and r = 0.464, p < 0.001, respectively).


CONCLUSIONS
Baseline levels of acute-phase reactants, especially CRP, WBC, ESR, and increased Wagner grade, appeared to be helpful in predicting amputation and length of stay in diabetic patients with acute foot ulceration. However, duration of diabetes and glucose control seems to have no effect.
Department of Endocrinology, Gaziantep University Faculty of Medicine, Gaziantep, Turkey, suzan2471@yahoo.com.tr.
Suzan
S
Tabur
Mehmet Ali
MA
Eren
Yakup
Y
Çelik
Omer Faruk
OF
Dağ
Tevfik
T
Sabuncu
Zeynel Abidin
ZA
Sayiner
Esen
E
Savas
D000671:Amputation, Surgical / Q000706:statistics & numerical data*; D017719:Diabetic Foot / Q000453:epidemiology* / Q000601:surgery*; D005260:Female; D006801:Humans; D015994:Incidence; D007902:Length of Stay / Q000706:statistics & numerical data*; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D018570:Risk Assessment; D017678:Sex Distribution; D014421:Turkey / Q000453:epidemiology