| Objective:By analyzing the clinical data of inpatients with diabetic foot,to understand the epidemiological characteristics of diabetic foot and the related risk factors of amputation,then provide feasible reference for clinical treatment and disease prevention.Methods:Collect the clinical data of inpatients with diabetic foot in the first affiliated Hospital of Nanchang University from January 1,2015,to December 31,2018.There are 732 inpatients with diabetic foot met the inclusion and exclusion criteria.first analyze the clinical data of the patients,then divide the patients into amputation group and non-amputation group according to amputation or not,analyzing the independent risk factors of amputation.Results:1.Epidemiological data of inpatients with diabetic foot(1)A total of 732 cases were collected,including 729 cases(99.6%)of type 2diabetes,2 cases(0.3%)of type 1 diabetes and 1 cases(0.1%)of other types.500males(68.3%)and 232 females(31.7%).The ratio of male to female was 2.16: 1.(2)The age distribution ranged from 31-86 years old,with an average age of61.7 ± 11.2 years,50-59-year-old patients are the most(224cases,30.7%),and there are 408(55.7%)patients aged 60 and above.The average age of male patients was60.2±10.6 years old,and the most common age was 50-59 years old(167 cases,33.4%);the average age of female patients was 64.8±11.7 years old,and the most common age was 70-79 years old(67 cases,28.9%).(3)The patients’ course of diabetes was 10(5,15)years,and there were 379 cases ≥10 years(52.8%).The patients’ course of diabetic foot was 30(15,90)days,and there were 18 cases(2.5%)≤1 days,73 cases(10%)in 2-7 days,369 cases(50.4%)in 8-30 days and 272 cases(37.1%)>30 days.(4)There are 291 cases(39.8%)had smoking experience and 220 cases(30.1%)had drinking experience.(5)Seasonal distribution of admission: the most hospitalized patients were admitted in winter(238 cases,32.5%),followed by spring(191 cases,26.1%),summer(154cases,21.0%)and autumn(149 cases,20.4%).(6)The patients’ duration of hospitalization was 15(9,28)days,and the hospitalization cost was 21892(11214,47019)yuan.The average duration of hospitalization in surgery was longer than in internal medicine [23(13,41)d VS 14(9,24)d].The average hospitalization cost of surgery was higher than that of internal medicine[37543.5(17808.75,69638.5)yuan VS 15048(9786,32903)yuan].(7)The most common cause of ulcer was injury,with 129 cases(17.6%);foot ulcer caused by daily behavior was the most common,with 275 cases(37.6%),including 90 cases(12.3%)of unsuitable footwear,74 cases(10.1%)of exposure to heat,44 cases(6.0%)of foot bath,36 cases(4.9%)of improper callus treatment and31 cases(4.2%)of toenail injury;there were 133 cases(18.2%)of foot ulcers caused by diabetic foot complications,including 80 cases(10.9%)caused by spontaneous blisters,43 cases(5.9%)caused by scratching by itching,and 10 cases(1.4%)caused by dry skin;there were 67 cases(9.2%)of foot ulcers caused by other causes.The cause of 128 cases(17.5%)was unknown,including 12 cases(1.6%)not recorded by doctors and 116 cases(15.8%)recorded as unknown causes.(8)In terms of ulcer distribution,the right foot was more prone to ulcer than the left foot(55.5% VS 44.5%).The most common sites of ulcer were as follows: toe(56.4%)> sole(14.0%)> dorsum of foot(12.1%)> ankle(9.6%)> heel(7.9%).The common sites of ulcers were as follows: 1st toe > 5th toe > plantar > dorsalis pedis >2nd toe > 4th toe > heel > 3rd toe > lateral malleolus > medial malleolus.After subdividing the left and right feet,the first nine sites of ulcer were in the following order: right 1st toe > right 5st toe > left plantar > right plantar > left dorsalis > left 5st toe > right 4st toe > left 1st toe > left 2st toe.In the amputation group,the first three sites of ulcer were in the following order: the fifth toe > the fourth toe > the first toe.In the unamputated group,the first three sites of ulcer were as follows: plantar >dorsum of foot > first toe.(9)Wagner grade 1 accounted for the most(297 cases,40.57%),followed by level 2(155 case,21.17%),level 3(100 cases,13.66%),level 4(78 cases,10.66%),grade 0(78 cases,10.66%)and level 5(24 cases,3.28%).There were no amputation patients in grades 0 and 1,and 2 cases(8.3%)of palliative treatment of unamputated patients in grade 5.With the increase of Wagner grade,the amputation rate increased gradually.(10)There were 150 cases(20.5%)of amputations,including 66 cases(9.0%)of major amputations and 84 cases(11.5%)of minor amputations.Major amputation easily occurs in the age group of 60-69 years old(52 cases,42.4%),and the incidence of minor amputation is the highest in the age group of 50-59 years old and 60-69 years old(29.5% respectively).In terms of distribution of amputations,minor amputations were most likely to occur in the fourth and fifth toes of the right foot and fifth toes of the left foot,and major amputations were the most likely to occur in the right calf.(11)Among the diabetic foot patients with Wagner grade 3 and above,the amputation rate in the burn department was lower than that in the orthopedics department(53.2% vs 80.7%).(12)Among the comorbidities and complications,hypertension accounts for57.8%(423 cases),coronary heart disease accounts for 29.6%(217 cases),cerebrovascular disease accounts for 21.2%(155 cases),retinopathy accounts for60.1%(440 cases),peripheral neuropathy accounts for 75.5%(553 cases),and DKD accounts for 59.6%(553 cases).Lower limb atherosclerosis accounts for 88.7%(649cases).2.The independent risk factors of diabetic foot amputation(1).Single factor analysis showed the following:There was no statistical significance in the differences of sex,age,course of diabetic foot,course of diabetes,history of smoking and drinking,history of coronary heart disease and cerebral infarction,diabetic retinopathy,diabetic kidney disease,diabetic peripheral neuropathy,blood urea nitrogen,serum creatinine,glycosylated serum protein,total cholesterol,low density lipoprotein cholesterol betweenamputation group and unamputated group(P>0.05).The amputation group had higher white blood cells count,C-reactive protein,fasting blood glucose,neutrophil lymphocyte ratio,wagner grade,prevalence of hypertension and prevalence of atherosclerosis of lower extremities than the unamputation group,and the difference had statistical significance(P<0.05).The amputated group had lower albumin,triglyceride,high-density lipoprotein cholesterol than the unamputated group,and the difference had statistical significance(P < 0.05).(2)Multivariate logistics regression analysis showed the following:C-reactive protein increased(OR = 1.03,95% CI 1.02-1.03,P <0.05),white blood cell count increased(OR = 1.14,95% CI 1.05-1.25,P <0.05),Wagner grade increased(OR = 8.40,95% CI 5.63-12.53,P <0.05)were the independent risk factors of diabetic foot amputation.The decrease of neutrophil lymphocyte ratio(OR = 0.84,95% CI 0.77-0.93,P <0.05)were the protective factor of diabetic foot amputation.Conclusion:1.Diabetic foot mostly occurs in men,most patients are older,the course of disease is long,the delay in treatment is serious,the hospitalization cost is high,the duration of hospitalization is long,the amputation rate is high,and there are many comorbidities and complications.DF patients were most frequently admitted in winter.2.There are many inducements of diabetic foot ulcer and the most common cause of ulcer is injury;in addition,daily behaviors also occupies a large proportion.3.The most common sites of diabetic foot ulcer are toe,sole and dorsum of foot.Ulcers in the right foot are more likely to occur in the toes,and ulcers in the left foot are more likely to occur in the sole and dorsum of the foot.Ulcers in the toes are more likely to lead to amputation.Most of the major amputation sites were in the right leg,and the minor amputation sites were mostly in the 4th and 5th toes of the right foot and the 5th toes of the left foot.4.The independent risk factors of diabetic foot amputation are C-reactive protein increased and Wagner grade increased,the independent protective factors isneutrophil lymphocyte ratio. |
PDF Full Text Request