Diyabetik ayaklı hastalarda ABO kan gruplarına göre diz üstü amputasyon ve mortalite risk değerlendirmesi

Abstract

Amaç: Bu çalışmada, majör eklem amputasyonu geçiren diyabetik hastalarda ABO kan gruplarının dağılımını değerlendirmek ve hangi kan grubunun diz üstü amputasyon (AKA) ve mortalite riskiyle ilişkili olduğunu belirlemek amaçlanmıştır. Gereç ve Yöntemler: Bu retrospektif çalışmaya Ocak 2020 ile Ocak 2024 arasında majör alt ekstremite amputasyonu geçiren 120 diyabetik ayak hastası dahil edilmiştir. Demografik, klinik ve laboratuvar verileri elektronik hasta kayıtlarından retrospektif olarak toplanmıştır. Hastalar ABO kan grubuna göre sınıflandırılmış ve AKA sıklığı ve mortalite oranları gruplar arasında karşılaştırılmıştır. Bulgular: Hastaların ortalama yaşı 66,5 ± 11,9 yıl ve ortanca hastalık süresi 17 yıldı. AKA sıklığı A kan grubunda %46,3, B kan grubunda %54,2, AB kan grubunda %50 ve O kan grubunda %28,2 idi. AKA ve mortalite oranları O kan grubu olmayan hastalarda O kan grubu olanlara göre daha yüksekti (%28,2'ye karşı %49,4, p = 0,032 AKA için; %48,7'ye karşı %67,9, p = 0,048 mortalite için; sırasıyla). Diğer karıştırıcı faktörlerden bağımsız olarak, O kan grubunun AKA riski 3,12 kat (1/OR) daha düşüktü (OR =0,32, p = 0,049) ve mortalite riski 2,17 kat (1/HR) daha düşüktü (HR =0,46, p = 0,045). Sonuç: Bu çalışma, diyabetik ayak hastalarında amputasyon şiddetini ve mortaliteyi etkileyen potansiyel bir faktör olarak ABO kan grubunu tanımlamaktadır. O kan grubu, AKA ve mortaliteye karşı koruyucu bir etki sağlıyor gibi görünmektedir, buna karşın O olmayan gruplar, özellikle B, daha kötü sonuçlara doğru bir eğilim göstermektedir.

Keywords

• ABO kan grubu
• diyabetik ayak
• diz üstü amputasyon
• sağkalım

Risk evaluation of above-knee amputation and mortality according to ABO blood groups in patients with diabetic foot

Abstract

Aims: This study aimed to assess the distribution of ABO blood groups in diabetic patients who underwent major joint amputation and to identify which blood group is related to the risk of above-knee amputation (AKA) and mortality. Methods: This retrospective study included 120 diabetic foot patients who underwent major lower-extremity amputation between January 2020 and January 2024. Demographic, clinical, and laboratory data were retrospectively collected from electronic patient records. Patients were stratified by ABO blood group, and the frequency of AKA and mortality rates were compared across groups. Results: The mean age of patients were 66.5 ± 11.9 years and median disease duration was 17 years. The frequency of AKA was 46.3% in blood group A, 54.2% in blood group B, 50% in blood group AB, and 28.2% in blood group O. AKA and mortality rates were higher in patients with non-O blood groups than in those with blood group O (28.2% vs. 49.4%, p = 0.032 for AKA; 48.7% vs. 67.9%, p = 0.048 for mortality; respectively). Independent of other confounders, blood group O had a 3.12-fold (1/OR) lower risk of AKA (OR =0.32, p = 0.049) and a 2.17-fold (1/HR) lower risk of mortality (HR =0.46, p = 0.045) compared to non-O blood groups. Conclusion: This study identifies ABO blood group as a potential factor influencing amputation severity and mortality in diabetic foot patients. Blood group O appears to confer a protective effect against AKA and mortality, whereas non-O groups, particularly B, show a tendency toward worse outcomes.

Keywords

• ABO blood group
• diabetic foot
• above-knee amputation
• survival

References

1. Armstrong DG, Boulton AJM, and Bus SA. Diabetic Foot Ulcers and Their Recurrence. N Engl J Med. 2017;376(24):2367-75. DOI: 10.1056/NEJMra1615439.
2. Akkus G and Sert M. Diabetic foot ulcers: A devastating complication of diabetes mellitus continues non-stop in spite of new medical treatment modalities. World J Diabetes. 2022;13(12):1106-21. DOI: 10.4239/wjd.v13.i12.1106.
3. Pemayun TG, Naibaho RM, Novitasari D, Amin N, and Minuljo TT. Risk factors for lower extremity amputation in patients with diabetic foot ulcers: a hospital-based case-control study. Diabet Foot Ankle. 2015;6:29629. DOI: 10.3402/dfa.v6.29629.
4. Subramaniam B, Pomposelli F, Talmor D, and Park KW. Perioperative and long-term morbidity and mortality after above-knee and below-knee amputations in diabetics and nondiabetics. Anesth Analg. 2005;100(5):1241-47. DOI: 10.1213/01.ANE.0000147705.94738.31.
5. McDermott K, Fang M, Boulton AJM, Selvin E, and Hicks CW. Etiology, Epidemiology, and Disparities in the Burden of Diabetic Foot Ulcers. Diabetes Care. 2023;46(1):209-21. DOI: 10.2337/dci22-0043.
6. Huang YY, Lin CW, Yang HM, Hung SY, and Chen IW. Survival and associated risk factors in patients with diabetes and amputations caused by infectious foot gangrene. J Foot Ankle Res. 2018;11:1. DOI: 10.1186/s13047-017-0243-0.
7. Getawa S, Bayleyegn B, Aynalem M, Worku YB, and Adane T. Relationships of ABO and Rhesus blood groups with type 2 diabetes mellitus: a systematic review and meta-analysis. J Int Med Res. 2022;50(10):3000605221129547. DOI: 10.1177/03000605221129547.
8. Pike MM, Larson NB, Wassel CL, et al. ABO blood group is associated with peripheral arterial disease in African Americans: The Multi-Ethnic Study of Atherosclerosis (MESA). Thromb Res. 2017;153:1-6. DOI: 10.1016/j.thromres.2017.02.018.

9. Evsen A, Aktan A, Kilic R, and Ozbek M. Association Between ABO Blood Group, Peripheral Artery Disease Lesion Severity, and Coronary Artery Disease Coexistence. Ann Vasc Surg. 2025; DOI: 10.1016/j.avsg.2024.12.067.
10. Gunaydin ZY and Yilmaz E. The association between ABO blood groups and TASC II classification in patients with peripheral artery disease. Vascular. 2023;31(3):467-72. DOI: 10.1177/17085381211068736.
11. Kamakshi R. To Determine the Blood Group Correlation among the Cases of Dysvascular Amputation: Retrospective Study. Indian Journal of Physical Medicine & Rehabilitation. 2024;34(1):40-43.
12. Amundadottir L, Kraft P, Stolzenberg-Solomon RZ, et al. Genome-wide association study identifies variants in the ABO locus associated with susceptibility to pancreatic cancer. Nat Genet. 2009;41(9):986-90. DOI: 10.1038/ng.429.
13. Farias AJ, Wu AH, Porcel J, et al. Diabetes-Related Complications and Pancreatic Cancer Incidence in the Multiethnic Cohort. JNCI Cancer Spectr. 2020;4(5):pkaa035. DOI: 10.1093/jncics/pkaa035.
14. Barnes JA, Eid MA, Creager MA, and Goodney PP. Epidemiology and Risk of Amputation in Patients With Diabetes Mellitus and Peripheral Artery Disease. Arterioscler Thromb Vasc Biol. 2020;40(8):1808-17. DOI: 10.1161/ATVBAHA.120.314595.
15. Soyoye DO, Abiodun OO, Ikem RT, Kolawole BA, and Akintomide AO. Diabetes and peripheral artery disease: A review. World J Diabetes. 2021;12(6):827-38. DOI: 10.4239/wjd.v12.i6.827.
16. O'Donnell J and Laffan MA. The relationship between ABO histo-blood group, factor VIII and von Willebrand factor. Transfus Med. 2001;11(4):343-51. DOI: 10.1046/j.1365-3148.2001.00315.x.
17. Ward SE, O'Sullivan JM, and O'Donnell JS. The relationship between ABO blood group, von Willebrand factor, and primary hemostasis. Blood. 2020;136(25):2864-74. DOI: 10.1182/blood.2020005843.
18. He M, Wolpin B, Rexrode K, et al. ABO blood group and risk of coronary heart disease in two prospective cohort studies. Arterioscler Thromb Vasc Biol. 2012;32(9):2314-20. DOI: 10.1161/ATVBAHA.112.248757.
19. Zakai NA, Judd SE, Alexander K, et al. ABO blood type and stroke risk: the REasons for Geographic And Racial Differences in Stroke Study. J Thromb Haemost. 2014;12(4):564-70. DOI: 10.1111/jth.12507.
20. Paterson AD, Lopes-Virella MF, Waggott D, et al. Genome-wide association identifies the ABO blood group as a major locus associated with serum levels of soluble E-selectin. Arterioscler Thromb Vasc Biol. 2009;29(11):1958-67. DOI: 10.1161/ATVBAHA.109.192971.
21. Zhang J, Huang S, Zhu Z, Gatt A, and Liu J. E-selectin in vascular pathophysiology. Front Immunol. 2024;15:1401399. DOI: 10.3389/fimmu.2024.1401399.
22. Muellner SK, Haut ER, Streiff MB, Holcomb JB, and Cotton BA. ABO blood group as a potential risk factor for venous thromboembolism in acutely injured patients. Thromb Haemost. 2011;105(1):5-13. DOI: 10.1160/TH10-08-0504.
23. Streiff MB, Segal J, Grossman SA, Kickler TS, and Weir EG. ABO blood group is a potent risk factor for venous thromboembolism in patients with malignant gliomas. Cancer. 2004;100(8):1717-23. DOI: 10.1002/cncr.20150.
24. Butler EA, Parikh R, Grandi SM, Ray JG, and Cohen E. ABO and Rh blood groups and risk of infection: systematic review and meta-analysis. BMC Infect Dis. 2023;23(1):797. DOI: 10.1186/s12879-023-08792-x.
25. Elly U and Yusticia K. Association of Blood Type and Mortality of Covid-19: A Hospital-Based Study in National Referral Hospital, Indonesia. Afr J Infect Dis. 2023;17(2):23-27. DOI: 10.21010/Ajidv17i2.4.
26. Carpeggiani C, Coceani M, Landi P, Michelassi C, and L'Abbate A. ABO blood group alleles: A risk factor for coronary artery disease. An angiographic study. Atherosclerosis. 2010;211(2):461-6. DOI: 10.1016/j.atherosclerosis.2010.03.012.
27. Etemadi A, Kamangar F, Islami F, et al. Mortality and cancer in relation to ABO blood group phenotypes in the Golestan Cohort Study. BMC Med. 2015;13:8. DOI: 10.1186/s12916-014-0237-8.
28. Yaylaci S, Dheir H, Issever K, et al. The effect of abo and rh blood group antigens on admission to intensive care unit and mortality in patients with COVID-19 infection. Rev Assoc Med Bras (1992). 2020;66Suppl 2(Suppl 2):86-90. DOI: 10.1590/1806-9282.66.S2.86.