Anemia In Patients With Diabetic Foot Ulcer: Incidence, Clinical Characteristics And Outcome

Aim:To describe the characteristics of diabetic foot ulcer (DFU) patients with anemia and assess the relationship between anemia and DFU outcome.Methods:A retrospective cohort study was conducted on patients with DFU attending our hospital (n=353) from May 2007 to September 2014. All variables in DFU patients with and without anemia according to the definition of the World Health Organization (WHO) were compared. The primary outcome of our study was combined desired outcome (healed) and adverse outcome (unhealed, amputation and death). The secondary outcome was amputation or death, respectively.Results:In this study,353 subjects (mean age 66.44 years) were included. Anemia was present in 236 patients (66.9%). These patients were significantly males, more likely to be smoker, had lower level of serum albumin, and worse kidney function, more likely to use at least two types of antibiotics and had worse perfusion of lower limb, larger extent and deeper of the ulcer and more severe infection. A multivariate analysis showed that male, lower serum albumin, worse kidney function were independent predictors of anemia in DFU patients. Additionally, in multivariate models, anemia was significantly and independently associated with adverse outcomes and with similar findings for secondary outcomes. Receiver operating characteristic (ROC) analysis determined a hemoglobin cutoff of 12.3g/dL (females) and 12.1g/dL (males) identified a high-risk population of DFU patients who would have adverse outcomes.Conclusions:Anemia is common in patients with DFU. Although typically mild or moderate, it has been associated with substantial morbidity and mortality in patients with DFU.