title: HDL cholesterol as a predictor for the incidence of lower extremity amputation and wound-related death in patients with diabetic foot ulcers.
abstract: OBJECTIVE
  We examined whether HDL cholesterol levels are a predictor for an incidence of lower-extremity amputation (LEA) and wound-related death in patients with diabetic foot ulcers (DFUs).
  
  
  METHODS
  This was a single-center, observational, longitudinal historical cohort study of 163 Japanese ambulatory patients with DFUs, 45 woman and 118 men, with a mean (standard deviation) age of 62 (14) years. The primary composite endpoint was defined as the worst of the following outcomes for each individual; (1) minor amputation, defined as amputation below the ankle, (2) major amputation, defined as amputation above the ankle, and (3) wound-related death.
  
  
  RESULTS
  During the median follow-up period of 5.1 months, 67 patients (41.1%) reached the endpoint (43 minor amputations, 16 major amputations, and 8 wound-related deaths). In the univariate Cox proportional hazard model analysis, lower HDL cholesterol levels (mmol/L) were significantly associated with the incidence of the primary composite endpoint (hazard ratio 0.16 [95% CI 0.08-0.32], p < 0.001). In the multivariate Cox proportional hazard model analysis using a stepwise variable-selecting procedure, HDL cholesterol levels in addition to the presence of ankle brachial index <0.9 or ≥1.4 and serum albumin levels were selected as independent risk factors for the incidence of the endpoint (hazard ratio 0.30 [95% CI 0.14-0.63], p = 0.002). Similar results were obtained when HDL cholesterol levels were treated as a categorical variable (≥1.03 mmol/L or less).
  
  
  CONCLUSIONS
  HDL cholesterol levels might be a novel clinical predictor for the incidence of LEA and wound-related death in patients with DFUs.
authors.affiliation: Diabetes Center, Tokyo Women's Medical University School of Medicine, Tokyo, Japan.
authors.forename: Kazuki
authors.initials: K
authors.lastname: Ikura
authors.affiliation: Diabetes Center, Tokyo Women's Medical University School of Medicine, Tokyo, Japan. Electronic address: hanai@dmc.twmu.ac.jp.
authors.forename: Ko
authors.initials: K
authors.lastname: Hanai
authors.affiliation: Diabetes Center, Tokyo Women's Medical University School of Medicine, Tokyo, Japan.
authors.forename: Takamichi
authors.initials: T
authors.lastname: Shinjyo
authors.affiliation: Diabetes Center, Tokyo Women's Medical University School of Medicine, Tokyo, Japan.
authors.forename: Yasuko
authors.initials: Y
authors.lastname: Uchigata
mesh_terms: D000368:Aged; D000671:Amputation, Surgical / Q000009:adverse effects / Q000401:mortality*; D055109:Ankle Brachial Index; D015415:Biomarkers / Q000097:blood; D008076:Cholesterol, HDL / Q000097:blood*; D017719:Diabetic Foot / Q000097:blood / Q000175:diagnosis / Q000401:mortality / Q000601:surgery; D005260:Female; D006801:Humans; D007564:Japan / Q000453:epidemiology; D053208:Kaplan-Meier Estimate; D008137:Longitudinal Studies; D035002:Lower Extremity / Q000098:blood supply*; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D011237:Predictive Value of Tests; D016016:Proportional Hazards Models; D012307:Risk Factors; D012709:Serum Albumin / Q000032:analysis; D000075462:Serum Albumin, Human; D013997:Time Factors; D016896:Treatment Outcome
chemical_list: C422455:ALB protein, human; D015415:Biomarkers; D008076:Cholesterol, HDL; D012709:Serum Albumin; D000075462:Serum Albumin, Human
keywords: Diabetic foot ulcer; HDL cholesterol; Lower extremity amputation