Analysis Of Factors Influencing Recurrent Diabetic Foot Ulcers

Objective:To discuss the related factors affecting the recurrence of diabetic foot ulcer,to provide clinical guidance for preventing the recurrence of foot ulcer,and to reduce the recurrence rate and hospitalization rate of foot ulcerMethods:From October 2015 to January 2020,241 patients with DFU who were treated and discharged were selected after complete healing from the Third Affiliated Hospital of Nanchang University.Screening according to inclusion and exclusion criteria,211patients were finally included in the study,and they were followed up for 2 years and divided into recurrence group(n=84)and non-recurrence group(n=127)according to the recurrence of foot ulcers during the follow-up period.The patient inpatient data from the hospital’s medical record system were collected for analysis.1)General demographic data,foot-related data,diabetic complications and comorbidities,and laboratory data of patients were analyzed and compared between the two groups.2)Univariate analysis was performed on the collected data.3)The statistically significant variables in univariate analysis were screened for Binary logistic regression analysis to explore the related factors of diabetic foot ulcer recurrence.4)The predictive value of total bilirubin on diabetic foot ulcer recurrence was explored by using the receiver operating characteristics(ROC)curve.Results:(1)The total recurrence rate of diabetic foot ulcers within 2 years was 39.8%.The mean age in the recurrence group was(65.82±12.93)years of which 56 were male and 28 were female.In the non-recurrence group,there were 85 males and 42 females,with an average age of(64.28±11.19)years.(2)Univariate analysis showed that there were no statistically significant differences between the two groups in terms of gender,age,duration of diabetes,education,glucose-lowering regimen,maximum area of initial ulcer(cm~2),callus,history of hypertension,history of coronary heart disease,history of cerebrovascular disease,history of thyroid disease,history of smoking and drinking.(3)There were significant differences between the two groups in body mass index(BMI),economic status,foot deformity,initial ulcer on the sole of the foot,history of previous amputation,Wagner classification of initial ulcer,history of lower extremity revascularization,duration of DFU(>60 days),diabetic peripheral neuropathy(DPN),peripheral vascular disease(PAD),osteomyelitis,glycosylated hemoglobin(Hb A1c),total bilirubin(TBIL),and C-reactive protein(CRP).(4)Binary logistic regression analysis showed that initial ulcer on the sole of the foot(OR=2.405,p=0.045),history of previous amputation(OR=6.758,p=0.027),diabetic peripheral neuropathy(OR=4.681,p=0.006)and peripheral arterial disease(OR=3.987,p<0.001)were independent risk factors for recurrence of diabetic foot ulcers,and serum total bilirubin(OR=0.886,p=0.036)was a protective factor for ulcer recurrence.(5)By ROC curve analysis,the ROC working curve area(AUC)of total bilirubin was 0.6518(95%CI:0.578～0.726,p<0.001),and the maximum Youden index was calculated to be 0.301,the optimal critical value of total bilirubin was 9.05,the corresponding sensitivity was 62.2%,and the specificity was 67.9%.Conclusion:Due to the high rate of long-term recurrence of diabetic foot ulcers,early screening and preventive education should be carried out to detect the influencing factors that may be related to ulcer recurrence as early as possible for the purpose of evaluation and treatment.