Abstract
DOI: 10.26650/cjm.2019.43.39
Objective: A diabetic foot ulcer with
progressive infection is a life-threatening condition that requires urgent
surgical intervention. Because of the severity of this condition, it is
important to understand its epidemiological and prognostic background. This
study aims to evaluate the epidemiology of the diabetic foot ulcer and describe
the etiology and the surgical procedures performed to treat it.
Methods: A retrospective review of 35
diabetic patients with foot ulcers was performed. These individuals were
admitted to the emergency department and were subsequently hospitalized between
April 2006 and April 2011. Factors affecting their mortality were statistically
assessed.
Results: The long duration of ulcer
treatment and need for intensive care were found significantly related to
mortality (p<0.05). There was a trend toward higher mortality in the patient
group with cardiac comorbidity (24% versus 20%), but this was not found to be
statistically significant.
Conclusion:
Infective diabetic foot ulcers may have a highly mortal course. Having
knowledge of how to discriminate between the acute infection and the factors
affecting patient mortality may lead us to making better prognoses and
delivering more effective treatment.
Cite this article as: Demiröz A, Arslan H.
Factors Affecting Mortality in Rapidly Progressive Diabetic Foot Ulcer
Patients. Cerrahpasa Med J 2019; 43(1): 23-28.
Keywords
References
- 1. American Diabetes Association. Foot wound care consensus conference. Diabetes Care 1999; 22: 1354-60. 2. Wallace GF. Debridment of invasive diabetic foot infections. Clin Plastic Surg 2007; 34: 731-4. 3. Lipsky BA, Berendt AR, Cornia PB, Pile JC, Peters EJ, Armstrong DG, et al. 2012 Infectious Diseases Society of America clinical practice guideline for the diagnosis and treatment of diabetic foot infections. Clin Infect Dis 2012; 54: e132-73. 4. Peters EJ, Lipsky BA, Aragón-Sánchez J, Boyko EJ, Diggle M, Embil JM, et al. Interventions in the management of infection in the foot in diabetes: a systematic review. Diabetes Metab Res Rev 2016; 32 (Suppl 1): 145-53. 5. Moulik PK, Mtonga R, Gill GV. Amputation and Mortality in New-Onset Diabetic Foot Ulcers Stratified by Etiology. Diabetes Care 2003; 26: 491-4. 6. Taylor LM Jr, Porter JM. The clinical course of diabetics who require emergent foot surgery because of infection or ischemia. J Vasc Surg 1987; 6: 454-9. 7. Capobianco CM, Stapleton JJ, Zgonis T. Surgical management of diabetic foot and ankle infections. Foot Ankle Spec 2010; 3: 223-30. 8. Altındaş M, Kılıç A, Çınar C. A reliable surgical approach for the two-staged amputation in unsalvageable limb and life threatening acute progressive diabetic foot infections: Tibiotalar disarticulation with vertical crural incisions and secondary transtibial amputation. Foot Ankle Surg 2011; 17: 13-8. 9. Lipsky BA. A report from the international consensus on diagnosing and treating the infected diabetic foot. Diabetes Metab Res Rev 2004; 20 (Suppl 1): S68-77. 10. Robbins JM, Strauss G, Aron D, Long J, Kuba J, Kaplan Y. Mortality Rates and Diabetic Foot Ulcers: Is it Time to Communicate Mortality Risk to Patients with Diabetic Foot Ulceration?. J Am Podiatr Med Assoc 2008; 98: 489-93. 11. Altindas M, Kilic A, Cinar C, Bingol UA, Ozturk G. The epidemiology of foot wounds in patients with diabetes: a description of 600 consecutive patients in Turkey. J Foot Ankle Surg 2011; 50: 146-52. 12. Tascini C, Piaggesi A, Tagliaferri E, Iacopi E, Fondelli S, Tedeschi A, et al. Microbiology at first visit of moderate-to-severe diabetic foot infection with antimicrobial activity and a survey of quinolone monotherapy. Diabetes Res Clin Pract 2011; 94: 133-9. 13. Aragón-Sánchez J, Hernández-Herrero MJ, Lázaro-Martínez JL, Quintana-Marrero Y, Maynar-Moliner M, Rabellino M, et al. In-hospital complications and mortality following major lower extremity amputations in a series of predominantly diabetic patients. Int J Low Extrem Wounds 2010; 9: 16-23. 14. Hambleton IR, Jonnalagadda R, Davis CR, Fraser HS, Chaturvedi N, Hennis AJ. All-cause mortality after diabetes-related amputation in Barbados: a prospective case-control study. Diabetes Care 2009; 32: 306-307. 15. Izumi Y, Satterfield K, Lee S, Harkless LB, Lavery LA. Mortality of first-time amputees in diabetics: a 10-year observation. Diabetes Res Clin Pract 2009; 83: 126-31. 16. Faglia E, Clerici G, Clerissi J, Gabrielli L, Losa S, Mantero M, et al. Early and five-year amputation and survival rate of diabetic patients with critical limb ischemia: data of a cohort study of 564 patients. Eur J Vasc Endovasc Surg 2006; 32: 484-90.
Abstract
DOI: 10.26650/cjm.2019.43.39
Amaç: Hızlı ilerleyici septik enfeksiyonla
seyreden diyabetik ayak yaraları son derece ölümcül durumlardır. Bu nedenle
hızlı bir cerrahi müdahale gerektirirler. Bu durumların ciddiyetinden ötürü
hastalığın epidemiyolojik ve prognostik altyapısının bilinmesi önemlidir. Bu
çalışmanın amacı; bu hasta grubunda epidemiyoloji, etiyoloji ve uygulanan
cerrahi prosedürlerin mortalite üzerine etkisini araştırmaktır.
Yöntemler: Nisan 2006 ile Nisan 2011
arasında acil polikliniğine başvuran ve acil yatış gerektiren 35 diyabetik ayak
yarası hastasının kayıtları retrospektif olarak tarandı. Hastaların yaş,
cinsiyet, eşlik eden hastalık, diyabet süresi, yara süresi, yara etiyolojisi,
mikrobiyolojik inceleme sonuçları, uygulanan cerrahi girişimler, operasyon
sonrası yoğun bakım ihtiyacı ve mortaliteleri incelendi. İstatistiksel olarak
diğer tüm parametrelerin mortalite ile korelasyonu araştırıldı.
Bulgular: Yara süresinin uzun olması ve
postoperatif yoğun bakım ihtiyacı istatistiksel olarak anlamlı şekilde
mortalite ile korale bulundu (p<0,05). Kardiyak ek hastalık öyküsü bulunan
hasta grubunda mortalitenin daha yüksek olduğu görüldü ancak bu fark
istatistiksel olarak anlamlı bulunmadı (%24’e %20).
Sonuç: Enfekte diyabetik ayak yaraları son
derece ölümcül bir seyre sahip olabilir. Akut enfeksiyon ayrımını yapabilmek ve
mortalite üzerine etki eden faktörleri bilmek daha iyi bir prognoza ulaşmak
için yol gösterici olacaktır.
Cite this article as: Demiröz A, Arslan H.
Factors Affecting Mortality in Rapidly Progressive Diabetic Foot Ulcer
Patients. Cerrahpasa Med J 2019; 43(1): 23-28.
Keywords
References
- 1. American Diabetes Association. Foot wound care consensus conference. Diabetes Care 1999; 22: 1354-60. 2. Wallace GF. Debridment of invasive diabetic foot infections. Clin Plastic Surg 2007; 34: 731-4. 3. Lipsky BA, Berendt AR, Cornia PB, Pile JC, Peters EJ, Armstrong DG, et al. 2012 Infectious Diseases Society of America clinical practice guideline for the diagnosis and treatment of diabetic foot infections. Clin Infect Dis 2012; 54: e132-73. 4. Peters EJ, Lipsky BA, Aragón-Sánchez J, Boyko EJ, Diggle M, Embil JM, et al. Interventions in the management of infection in the foot in diabetes: a systematic review. Diabetes Metab Res Rev 2016; 32 (Suppl 1): 145-53. 5. Moulik PK, Mtonga R, Gill GV. Amputation and Mortality in New-Onset Diabetic Foot Ulcers Stratified by Etiology. Diabetes Care 2003; 26: 491-4. 6. Taylor LM Jr, Porter JM. The clinical course of diabetics who require emergent foot surgery because of infection or ischemia. J Vasc Surg 1987; 6: 454-9. 7. Capobianco CM, Stapleton JJ, Zgonis T. Surgical management of diabetic foot and ankle infections. Foot Ankle Spec 2010; 3: 223-30. 8. Altındaş M, Kılıç A, Çınar C. A reliable surgical approach for the two-staged amputation in unsalvageable limb and life threatening acute progressive diabetic foot infections: Tibiotalar disarticulation with vertical crural incisions and secondary transtibial amputation. Foot Ankle Surg 2011; 17: 13-8. 9. Lipsky BA. A report from the international consensus on diagnosing and treating the infected diabetic foot. Diabetes Metab Res Rev 2004; 20 (Suppl 1): S68-77. 10. Robbins JM, Strauss G, Aron D, Long J, Kuba J, Kaplan Y. Mortality Rates and Diabetic Foot Ulcers: Is it Time to Communicate Mortality Risk to Patients with Diabetic Foot Ulceration?. J Am Podiatr Med Assoc 2008; 98: 489-93. 11. Altindas M, Kilic A, Cinar C, Bingol UA, Ozturk G. The epidemiology of foot wounds in patients with diabetes: a description of 600 consecutive patients in Turkey. J Foot Ankle Surg 2011; 50: 146-52. 12. Tascini C, Piaggesi A, Tagliaferri E, Iacopi E, Fondelli S, Tedeschi A, et al. Microbiology at first visit of moderate-to-severe diabetic foot infection with antimicrobial activity and a survey of quinolone monotherapy. Diabetes Res Clin Pract 2011; 94: 133-9. 13. Aragón-Sánchez J, Hernández-Herrero MJ, Lázaro-Martínez JL, Quintana-Marrero Y, Maynar-Moliner M, Rabellino M, et al. In-hospital complications and mortality following major lower extremity amputations in a series of predominantly diabetic patients. Int J Low Extrem Wounds 2010; 9: 16-23. 14. Hambleton IR, Jonnalagadda R, Davis CR, Fraser HS, Chaturvedi N, Hennis AJ. All-cause mortality after diabetes-related amputation in Barbados: a prospective case-control study. Diabetes Care 2009; 32: 306-307. 15. Izumi Y, Satterfield K, Lee S, Harkless LB, Lavery LA. Mortality of first-time amputees in diabetics: a 10-year observation. Diabetes Res Clin Pract 2009; 83: 126-31. 16. Faglia E, Clerici G, Clerissi J, Gabrielli L, Losa S, Mantero M, et al. Early and five-year amputation and survival rate of diabetic patients with critical limb ischemia: data of a cohort study of 564 patients. Eur J Vasc Endovasc Surg 2006; 32: 484-90.
Details
| Primary Language | Turkish |
|---|---|
| Subjects | Clinical Sciences |
| Journal Section | Araştırmalar |
| Authors | |
| Publication Date | July 1, 2019 |
| Published in Issue | Year 2019 Volume: 43 Issue: 1 |
