title: Indicators of prognosis for admissions from a specialist diabetic foot clinic: a retrospective service improvement exercise.
abstract: OBJECTIVE
  To look at haematological and biochemical variables as predictors of outcomes in people admitted to hospital with a diabetic foot ulcer (DFU) without the use of technology or devices. In particular, to see if there was a relationship between admission blood cell and protein levels, and the likelihood of angioplasty, amputation, and death at one year after admission.
  
  
  METHODS
  A five-year retrospective analysis of patients admitted to a tertiary multidisciplinary specialist diabetic foot clinic looking at admission C-reactive protein (CRP), white cell count (WCC), neutrophil count and HbA1c and their relationship to likelihood of angioplasty, minor or major amputation, and death at one year after admission.
  
  
  RESULTS
  We identified 206 patients, in whom there was 1 year mortality rate of 6.3%. Raised WCC and CRP levels were significantly associated with major amputation (p=0.0035 and p<0.01, respectively). Raised WCC and neutrophil levels and were significantly associated with mortality (p=0.01 and p=0.002, respectively). The need for angioplasty was associated with raised CRP (p<0.05) but not with WCC or neutrophil count. There was no association of risk of minor amputations with admission HbA1c, CRP, WCC and neutrophils. Mean length of hospital stay was 17.5 (standard deviation ±14.0) days.
  
  
  CONCLUSIONS
  Commonly measured haematological and biochemical markers were useful predictors of outcomes for patients admitted to hospital for acute foot wounds. In addition, we found a much lower 1 year mortality and shorter length of hospital stay than previously recorded, possibly due to the introduction of a multidisciplinary weekly ward round.
authors.affiliation: Norwich Medical School, University of East Anglia, Norwich, UK.
authors.forename: Z
authors.initials: Z
authors.lastname: Essackjee
authors.affiliation: Diabetic Foot Clinic, Elsie Bertram Diabetes Centre, Norfolk and Norwich University Hospitals NHS Foundation Trust, Norwich, UK.
authors.forename: C
authors.initials: C
authors.lastname: Gooday
authors.affiliation: Norwich Medical School, University of East Anglia, Norwich, UK.
authors.forename: I
authors.initials: I
authors.lastname: Nunney
authors.affiliation: Diabetic Foot Clinic, Elsie Bertram Diabetes Centre, Norfolk and Norwich University Hospitals NHS Foundation Trust, Norwich, UK.
authors.forename: K
authors.initials: K
authors.lastname: Dhatariya
mesh_terms: D000368:Aged; D000671:Amputation, Surgical; D017719:Diabetic Foot / Q000601:surgery; D015444:Exercise; D006801:Humans; D012189:Retrospective Studies; D016896:Treatment Outcome
keywords: C-reactive protein; amputation; angioplasty; diabetic foot; mortality; neutrophils; prognosis; risk