title: Risk Factors for Foot Amputation in Patients Hospitalized for Diabetic Foot Infection.
abstract: The aim of this study was to identify and quantify risk factors for amputation in diabetic patients hospitalized for foot infections. This cross-sectional study comprised 100 patients with diabetic infectious complications in the lower limbs. The variables investigated were related to diabetes, infection, and treatment compliance. Multiple Cox regression analysis was performed to identify the variables independently associated with the outcome of amputation. The most prevalent chronic complications were neuropathy and hypertension. Most patients presented with a neuroischemic foot (86%). The Morisky test showed that 72% were not compliant with diabetes treatment. Regarding patient outcome, 61% progressed to amputation, 14% to debridement, and 9% to revascularization. The results showed a 42% higher risk for progression to amputation in patients with previous use of antimicrobials. Also, the amputation risk was 26% higher for those less compliant with diabetes treatment. An increase of one point in the Wagner ulcer classification criteria corresponded to a 65% increase in the risk of amputation. Undergoing conservative, nonsurgical procedures prior to admission provided a 63% reduction in the risk of amputation. Knowledge of these factors is critical to enable multidisciplinary teams to develop treatment plans for these patients so as to prevent the need for amputation.
authors.affiliation: Pontifícia Universidade Católica de São Paulo, Sorocaba, SP, Brazil.
authors.forename: Maria Teresa Verrone
authors.initials: MT
authors.lastname: Quilici
authors.affiliation: University of Sorocaba, Rodovia Raposo Tavares, Km 92,5, 18023-000 Sorocaba, SP, Brazil.
authors.forename: Fernando de Sá
authors.initials: Fde S
authors.lastname: Del Fiol
authors.affiliation: Pontifícia Universidade Católica de São Paulo, Sorocaba, SP, Brazil.
authors.forename: Alexandre Eduardo Franzin
authors.initials: AE
authors.lastname: Vieira
authors.affiliation: Universidade de Brasília, Brasília, DF, Brazil.
authors.forename: Maria Inês
authors.initials: MI
authors.lastname: Toledo
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000671:Amputation, Surgical; D001938:Brazil / Q000453:epidemiology; D003430:Cross-Sectional Studies; D003646:Debridement; D017719:Diabetic Foot / Q000175:diagnosis / Q000453:epidemiology / Q000382:microbiology / Q000601:surgery*; D018450:Disease Progression; D005260:Female; D006760:Hospitalization; D006801:Humans; D007004:Hypoglycemic Agents / Q000627:therapeutic use; D008297:Male; D055118:Medication Adherence; D008875:Middle Aged; D015999:Multivariate Analysis; D015995:Prevalence; D016016:Proportional Hazards Models; D018570:Risk Assessment; D012307:Risk Factors; D014656:Vascular Surgical Procedures; D014946:Wound Infection / Q000175:diagnosis / Q000453:epidemiology / Q000382:microbiology / Q000601:surgery*
chemical_list: D007004:Hypoglycemic Agents