Factores asociados con amputación de miembros inferiores de pacientes con pie diabético en una cohorte
DOI:
https://doi.org/10.1016/j.rccot.2022.07.004Palabras clave:
pie diabético, diabetes mellitus, amputación, ultrasonografía doppler, leucocitosis, HbA1cResumen
Introducción: El desarrollo de ulceraciones en el Pie Diabético (PD) puede derivar en amputación de miembros inferiores e incluso impactar la morbi mortalidad de los pacientes diabéticos. Por lo anterior, este estudio pretende evaluar las características de los pacientes con PD hospitalizados y manejados en un hospital regional.
Materiales y métodos: 121 pacientes son incluidos en el estudio de cohorte retrospectiva entre amputados y no amputados, tomados de la base de datos del hospital entre enero de 2013 y enero de 2018. Los datos demográficos, así como factores relacionados fueron analizados con regresión logística bi y multivariada en relación con la amputación de miembro inferior como variable de desenlace, calculando razón de probabilidades (OR) con intervalos de confianza del 95%. Dicha información fue analizada con el programa estadístico STATA.
Resultados: 81 pacientes requirieron amputación de miembros inferiores. En la regresión logística bivariada hay 3 factores relacionados con amputación [nivel de Wagner (p < 0.05 CI 95%), la presencia de leucocitosis (p <0.05 CI 95%) y el compromiso vascular en Doppler arterial (p < 0.05 CI 95%)], sin embargo, la regresión multivariada sólo relaciona el compromiso vascular del Doppler arterial como estadísticamente significativo con amputación de miembros inferiores (p < 0.05 CI 95%).
Conclusión: Se muestran 3 factores estadísticamente significativos con la amputación de miembros inferiores en PD (Wagner, leucocitosis y compromiso vascular), reflejando la importancia de un diagnóstico temprano y un manejo adecuado como parte clave en el manejo de esta patología.
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Referencias bibliográficas
Yazdanpanah L, Nasiri M, Adarvishi S. Literature review on the management of diabetic foot ulcer. World J Diabetes. 2015;6:37, https://doi.org/10.4239/wjd.v6.i1.37
Pendsey SP. Understanding diabetic foot. Int J Diabetes Dev Ctries. 2010;30:75, https://doi.org/10.4103/0973-3930.62596
Aragón-Sánchez J, Lázaro-Martínez JL, Hernández-Herrero C, Campillo-Vilorio N, Quintana-Marrero Y, García-Morales E, et al. Surgical treatment of limband life-threatening infections in the feet of patients with diabetes and at least one palpable pedal pulse: successes and lessons learnt. Int J Low Extrem Wounds. 2011;10:207-13, https://doi.org/10.1177/1534734611426364
Morbach S, Furchert H, Gröblinghoff U, Hoffmeier H, Kersten K, Klauke GT, et al. Long-term prognosis of diabetic foot patients and their limbs: amputation and death over the course of a decade. Diabetes Care. 2012;35:2021-7, https://doi.org/10.2337/dc12-0200
Rümenapf G, Morbach S. What can I do with a patient with diabetes and critically impaired limb perfusion who cannot be revascularized? Int J Low Extrem Wounds. 2014;13:378-89, https://doi.org/10.1177/1534734614554283
Alavi A, Sibbald RG, Mayer D, Goodman L, Botros M, Armstrong DG, et al. Diabetic foot ulcers: Part I. Pathophysiology and prevention. J Am Acad Dermatol. 2014;70,https://doi.org/10.1016/j.jaad.2013.06.055
Federation ID. IDF Diabetes Atlas | Tenth Edition. 2022, https://diabetesatlas.org/.
Pinilla AE, Sánchez AL, Mejía A, del Pilar Barrera M. Actividades de prevención del pie diabético en pacientes de consulta externa de primer nivel. Rev Salud Pública. 2011;13: 262-73.
Tamayo DC. Descripción de la epidemiología actual. 2022, https://silo.tips/download/descripcion-de-la-epidemiologiaactual.
Jeon BJ, Choi HJ, Kang JS, Tak MS, Park ES. Comparison of five systems of classification of diabetic foot ulcers and predictive factors for amputation. Int Wound J.2017;14:537-45, https://doi.org/10.1111/iwj.12642
HuangY,XieT,CaoY,WuM,YuL,LuS,etal.Comparison of two classification systems in predicting the outcome of diabetic foot ulcers: the Wagner grade and the Saint Elian Wound score systems. Wound Repair Regen. 2015;23:379-85,https://doi.org/10.1111/wrr.12289
Amin N, Doupis J. Diabetic foot disease: From the evaluation of the ''foot at risk'' to the novel diabetic ulcer treatment modalities. World J Diabetes. 2016;7:153, https://doi.org/10.4239/wjd.v7.i7.153
Sherwani SI, Khan HA, Ekhzaimy A, Masood A, Sakharkar MK. Significance of HbA1c Test in Diagnosis and Prognosis of Diabetic Patients. Biomark Insights. 2016;11:95, https://doi.org/10.4137/BMI.S38440
Christman AL, Selvin E, Margolis DJ, Lazarus GS, Garza LA. Hemoglobin A1c is a Predictor of Healing Rate In Diabetic Wounds. J Invest Dermatol. 2011;131:2121, https://doi.org/10.1038/jid.2011.176
Zhou ZY, Liu YK, Chen HL, Yang HL, Liu F. HbA1c and Lower Extremity Amputation Risk in Patients With Diabetes: A Meta-Analysis. Int J Low Extrem Wounds. 2015;14:168-77,https://doi.org/10.1177/1534734615593190
Pemayun TGD, Naibaho RM, Novitasari D, Amin N, 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, https://doi.org/10.3402/dfa.v6.29629
Blumberg SN, Warren SM. Disparities in initial presentation and treatment outcomes of diabetic foot ulcers in a public, private, and Veterans Administration hospital. J Diabetes. 2014;6:68-75, https://doi.org/10.1111/1753-0407.12050
Papanas N, Maltezos E. Glycated Hemoglobin as a Risk Factor for Lower Extremity Amputations in Diabetes: ''Success Is Counted Sweetest.''. Int J Low Extrem Wounds. 2015;14:106-7, https://doi.org/10.1177/1534734615592313
Elgendi M. On the Analysis of Fingertip Photoplethysmogram Signals. Curr Cardiol Rev. 2012;8:14, https://doi.org/10.2174/157340312801215782
Varma P, Stineman MG, Dillingham TR. Epidemiology of limb loss. Phys Med Rehabil Clin N Am. 2014;25:1-8, https://doi.org/10.1016/j.pmr.2013.09.001
Nather A, Bee CS, Chan YH, Chew JLL, Lin CB, Neo S, et al. Epidemiology of diabetic foot problems and predictive factors for limb loss. J Diabetes Complications. 2008;22:77-82, https://doi.org/10.1016/j.jdiacomp.2007.04.004
Yang Y, Østbye T, Tan SB, Abdul Salam ZH, Yang KS, Ong BC. Risk factors for lower extremity amputation among patients with diabetes in Singapore. J Diabetes Complications. 2011;25:382-6, https://doi.org/10.1016/j.jdiacomp.2011.08.002
Nather A, Wong KL. Distal amputations for the diabetic foot. Diabet Foot Ankle. 2013:4, https://doi.org/10.3402/dfa.v4i0.21288
Pickwell K, Siersma V, Kars M, Apelqvist J, Bakker K, Edmonds M, et al. Predictors of lower-extremity amputation in patients with an infected diabetic foot ulcer. Diabetes Care. 2015;38:852-7, https://doi.org/10.2337/dc14-1598
Gershater MA, Löndahl M, Nyberg P, Larsson J, Thörne J, Eneroth M, et al. Complexity of factors related to outcome of neuropathic and neuroischaemic/ischaemic diabetic foot ulcers: a cohort study. Diabetologia. 2009;52:398-407, https://doi.org/10.1007/s00125-008-1226-2
Fleischer AE, Wrobel JS, Leonards A, Berg S, Evans DP, Baron RL, et al. Post-treatment leukocytosis predicts an unfavorable clinical response in patients with moderate to severe diabetic foot infections. J Foot Ankle Surg. 2011;50:541-6, https://doi.org/10.1053/j.jfas.2011.04.023
Cull DL, Manos G, Hartley MC, Taylor SM, Langan EM, Eidt JF, et al. An early validation of the Society for Vascular Surgery lower extremity threatened limb classification system. J Vasc Surg. 2014;60:1535-42, https://doi.org/10.1016/j.jvs.2014.08.107
Pemayun TGD, Naibaho RM, Novitasari D, Amin N, 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, https://doi.org/10.3402/dfa.v6.29629
Wang A, Xu Z, Mu Y, Ji L. Clinical characteristics and medical costs in patients with diabetic amputation and nondiabetic patients with nonacute amputation in central urban hospitals in China. Int J Low Extrem Wounds. 2014;13:17-21, https://doi.org/10.1177/1534734614521235
Ferraresi R, Centola M, Ferlini M, Da Ros R, Caravaggi C, Assaloni R, et al. Long-term outcomes after angioplasty of isolated, below-the-knee arteries in diabetic patients with critical limb ischaemia. Eur J Vasc Endovasc Surg. 2009;37:336-42, https://doi.org/10.1016/j.ejvs.2008.12.001
Chao CYL, Cheing GLY. Microvascular dysfunction in diabetic foot disease and ulceration. Diabetes Metab Res Rev. 2009;25:604-14, https://doi.org/10.1002/dmrr.1004
Ro DH, Moon HJ, Kim JH, Lee KM, Kim SJ, Lee DY. Photoplethysmography and continuous-wave Doppler ultrasound as a complementary test to ankle-brachial index in detection of stenotic peripheral arterial disease. Angiology. 2013;64:314-20, https://doi.org/10.1177/0003319712464814
Aiello A, Anichini R, Brocco E, Caravaggi C, Chiavetta A, Cioni R, et al. Treatment of peripheral arterial disease in diabetes: a consensus of the Italian Societies of Diabetes (SID, AMD). Radiology (SIRM) and Vascular Endovascular Surgery (SICVE). Nutr Metab Cardiovasc Dis. 2014;24:355-69, https://doi.org/10.1016/j.numecd.2013.12.007
Brownrigg JRW, Apelqvist J, Bakker K, Schaper NC, Hin- chliffe RJ. Evidence-based management of PAD & the diabetic foot. Eur J Vasc Endovasc Surg. 2013;45:673-81, https://doi.org/10.1016/j.ejvs.2013.02.014
Barshes NR, Gold B, Garcia A, Bechara CF, Pisimisis G, Kougias P. Minor amputation and palliative wound care as a strategy to avoid major amputation in patients with foot infections and severe peripheral arterial disease. Int J Low Extrem Wounds. 2014;13:211-9, https://doi.org/10.1177/1534734614543663
de Meijer VE, van't Sant HP, Spronk S, Kusters FJ, den Hoed PT. Reference value of transcutaneous oxygen measurement in diabetic patients compared with nondiabetic patients. J Vasc Surg. 2008;48:382-8, https://doi.org/10.1016/j.jvs.2008.03.010
Sinwar PD. The diabetic foot management - Recent advance. Int J Surg. 2015;15:27-30, https://doi.org/10.1016/j.ijsu.2015.01.023
Martins-Mendes D, Monteiro-Soares M, Boyko EJ, Ribeiro M, Barata P, Lima J, et al. The independent contribution of diabetic foot ulcer on lower extremity amputation and mortality risk. J Diabetes Complications. 2014;28:632-8, https://doi.org/10.1016/j.jdiacomp.2014.04.011
Malik RA, Tesfaye S, Ziegler D. Medical strategies to reduce amputation in patients with type 2 diabetes. Diabet Med. 2013;30:893-900, https://doi.org/10.1111/dme.12169
Liu S, He C, zhu, Cai Y, ting, Xing Q, ping, Guo Y, zhen, Chen Z, long, et al. Evaluation of negative-pressure wound therapy for patients with diabetic foot ulcers: systematic review and meta-analysis. Ther Clin Risk Manag. 2017;13:533-44, https://doi.org/10.2147/TCRM.S131193
