Correlation Analysis Of Evaluation Indicators On The Severity Of Diabetic Foot And Risk Factors For Lower Extremity Amputation In Patients With Diabetic Foot

Diabetes mellitus(DM)is the most common metabolic disorder.In recent years,the prevalence of Diabetes mellitus was significantly increased around the world.In 2013,a epidemiological survey showed that the incidence of DM in China reached 11.6%,the pre-diabetes was as much as 15.5%.Diabetic foot(DF)is one of the most serious chronic complications of diabetes.the lifetime risk of developing a foot ulcer is estimated to be 15% and diabetic foot(DF)has the characteristics of difficulty in treatment,high mortality,high disability rate and high treatment cost.DF has been the primary cause of amputation in many countries.The study aims to explore the correlation between the severity of diabetic foot(DF)and evaluation indicators and the risk factors of lower extremity amputation in hospitalized patients with diabetic foot,so as to provide the basis for the choice of treatment and the prognosis of the patients.The clinical data of 1820 patients with diabetic foot at the Air Force General Hospital from 2001 to 2015 were retrospectively analyzed,and the DM patients of type 1 and special type(21),Wagner 0 grade(28)were excluded from the study,and a total of 1771 DF patients with Wagner1~5 were recruited.In Univariate analyses,193 cases were removed from the non-amputation group because of more missing data,and the actual cases included in the study were 1578.they were divided into five groups according to the Wagner grade.Variance analysis and chi-square test were used between groups and Spearmen analysis was used to assess the selected evaluation indicators associated with Wagner grade;they were divided into non-amputation and amputation groups,while the amputation group included minor and major amputation groups.Univariate analyses was used between groups and binary logistic regression analyses was used to assess the independent effect of selected risk factors associated with lower extremity amputation.The research results: 1.Among 1771 patients with diabetic foot ulcers,41(2.32%)patients were major amputation,282(15.92%)were minor amputation,while 1448(81.76%)were non-amputation;The amputation rates of DF patients in Wagner1~2?3?4~5 were 0%?25 and 30%,respectively.2.With the increase of Wagner grade,the C-reaction protein(CRP)?erythrocyte sedimentation rate(ESR)?ferritin?hospital stays?hospitalization expense ? glycosylated hemoglobin(HbA1c)? fasting blood-glucose(FBG)and the incidences of peripheral arterial disease(PAD)?diabetic peripheral neuropathy(DPN)and diabetic retinopathy(DR)were higher in parents with DF,while hemoglobin(Hb)and body mass index(BMI)were lower.3.Spearmen analysis showed that PAD?DPN?HbA1c?FBG and infectious indexes(such as CRP?ESR and ferritin)positively and nutritive indexes(such as Hb and BMI)negatively were correlation with the severity of diabetic foot.4.The amputated patients had a longer hospitalized stay,higher estimated glomerular filtration rate(eGFR)and fasting plasma glucose(FPG),greater glycosylated hemoglobin(HbA1c),significant higher inflammatory indexes(C-reaction protein(CRP)?erythrocyte sedimentation rate(ESR)?ferritin?Fibrinogen(FIB)?white blood cell(WBC)and lower serum levels of hemoglobin?albumin?transferrin(TF)?triglyceride(TG)?total cholesterol(TC)?low density lipoprotein cholesterol(LDL-c)? high density lipoprotein cholesterol(HDL-c)than the non-amputation patients(P<0.05).5.The prevalence of Hypertension(52.48% VS 59.98%)?peripheral vascular disease(PAD)(68.11% VS 25.04%)?and coronary disease(21.33% VS 28.71%)were different between the amputation and non-amputation groups(P<0.05).6.Multivariable logistic regression identified Wagner's grade,PAD and CRP as the independent risk factors associated with lower extremity amputation in hospitalized patients with diabetic foot.The Conclusions in this study: PAD?DPN?HbA1c?FBG?infection factors and nutritional factors are regarded to be closely associated with the severity of diabetic foot.Especially,the ischemia and infection that will be more serious with the aggravation of the DF patient's condition,are also the independent risk factors of diabetic foot progression resulting in amputation.