Fewer major amputations; survival remains poor, especially with comorbid PAD, renal insufficiency
FRIDAY, July 27 (HealthDay News) -- For patients with diabetic foot ulcers (DFUs), long-term limb salvage is favorable; however, long-term survival remains poor, particularly for those with peripheral artery disease (PAD) or chronic renal insufficiency, according to a study published online July 18 in Diabetes Care.
To assess the correlation between patient and limb survival in patients with DFUs, Stephan Morbach, M.D., of the Marienkrankenhaus in Soest, Germany, and colleagues conducted a prospective study involving 247 consecutive patients with DFUs and without previous major amputation. Participants (mean age 68.8 years; 58.7 percent male; 55.5 with PAD) presented between June 1998 and December 1999 and were followed until May 2011.
The researchers found that 15.4 percent of patients experienced a first major amputation during follow-up. PAD was present in 37 of these 38 patients at study inclusion, and 51.4 percent had severe PAD. Significant predictors for the first major amputation included age (hazard ratio [HR], 1.05 per year), dialysis (HR, 3.51), and PAD (HR, 35.34). At years one, three, five, and 10, cumulative mortality rates were 15.4, 33.1, 45.8, and 70.4 percent, respectively. Death in these patients was significantly predicted by increasing age (HR, 1.08 per year), chronic renal insufficiency (HR, 1.83), dialysis (HR, 6.43), and PAD (HR, 1.44).
"In conclusion, data from this long-term study suggest strongly that limb preservation today is the rule rather than the exception, even in high-risk patients with diabetes," the authors write. "Long-term survival remains poor, however, probably because of myriad comorbid conditions for patients whose first presentation to an interdisciplinary clinic is with a diabetic foot ulcer."
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