Retrospective Analysis Of Case Data In284Patients With Diabetic Foot

Objective:To evaluate the causes, risk factors, severity of diabetic foot and prognostic factors of amputation.Methods:284inpatients with diabetic foot who met the inclusion criteria were enrolled in the Endocrinology department, the Second Xiangya Hospital of Central South University, from January,2006to December.2010. Their clinical data were collected for retrospective study. Binary Logistic regression analysis was used to identify risk factors for the severe diabetic foot and amputation.Results:①of these284patients,175were men and109were women. The average age was (60.7±11.6) years old, and82.4%of patients were older than50. Their average duration of diabetes was (10.0±6.3) years, the diabetes duration in77.5%patients with more than5years. Glycosylated hemoglobin (HbAlc) in86.5%patients higher than6.5%.②Diabetic foot ulcers mostly occured in the toe (43.1%). The main causes of diabetic foot were burn or scald (37.5%), and diabetic foot was often accompanied with diabetic nephropathy and diabetic retinopathy.③The positive rate of bacterial culture in Diabetic foot ulcer secretions of94.8%.④Serum albumin (ALB), total cholesterol, high density lipoprotein cholesterol (HDL-C), red blood cell count and hemoglobin in patients with Wagner3-5(Severe group) were lower than that in patients with Wagner0-2(Mild group)(P<0.05), and white blood cell count and platelet count in severe group were higher than that in mild group (P<0.05). Severe patients were predisposed to diabetic ketoacidosis, diabetic ketoacidosis, and mixed infections.⑤All of the amputation patients belonged to severe group.⑥The average days and costs of hospitalization in patients with severe diabetic foot and amputation were significantly higher than that in patients with mild diabetic foot and non-amputation patients (P<0.05).⑦ALB, total cholesterol, HDL-C in amputation patients were lower than that in non-amputation patients (P<0.05), and HbA1c,white blood cell count and platelet counts in amputation patients were higher than that in non-amputation patients (P<0.05).⑧Logistic regression analysis showed that high white blood cell count (OR=1.093,95%CI1.012-1.180) was a risk factor for severe diabetic foot, HDL-C (OR=0.388,95%CI0.162-0.931) was a protective factor. HbAlc (OR=1.411,95%CI1.077-1.849), extremity arterial occlusion (OR=6.114,95%CI1.202-31.094) were risk factors for amputation.Conclusions:①Diabetic foot mostly occured in patients over the age of50, with poor glycemic control, long durationand patients with diabetic foot usually already had incentives and pathogen infection.②Patients with severe diabetic foot and amputation had longer average length of hospital day and higher medical costs.③Infection was a risk factor for severe diabetic foot.④Infection, poor blood sugar control, especially lower extremity arterial occlusion increased the risk for diabetic foot amputation.