Diabetic Foot Ulcers Associated with Increased Mortality

Patients with diabetic foot ulcers (DFU) have a high mortality risk, researchers found in a recent study. 

Between January 2003 and June 2015, first-time DFU patients at the Multi-Disciplinary Foot Clinic at Royal Darwin Hospital, Northern Territory Australia were followed until 2017 or death. Hospital and primary care information systems were used to find individual patient data. Kaplan-Meier survival curves were used, and Cox regression was used to evaluate the association between certain risk factors and mortality. 

Of 666 patients who were screened, 513 were included in the study (median follow-up, 5.8 years; mean age at baseline, 59.9 years; 62.8% male). Nearly all (93.6%) patients had type 2 diabetes; median disease duration was seven years. One hundred ninety-nine patients died; nearly a quarter (24.6%) died within five years, and 45.4% died within a decade (mean age at death, 64.6 years). A multivariate analysis found that certain factors were also associated with mortality (adjusted HR, 95% CI), including age (1.04, 1.02–1.05, P < 0.001), chronic kidney disease (1.22, 1.11–1.33, P < 0.001), and plasma albumin (0.96, 0.94–0.99, P < 0.05). Patients were most likely to die due to chronic kidney disease (24.6%), cardiovascular events (19.6%), sepsis (15.6%), respiratory failure (10.0%), malignancy (9.5%) and multi-organ failure (5.0%). 

One of the study’s limitations was its retrospective nature, allowing for potential ascertainment bias. There were also no patients with simple superficial ulcers included in the study, as those are treated in a primary care setting, meaning the study’s findings may not apply to this population. 

The researchers concluded, “The presence of a DFU should be seen by health care providers as an alarming signal to premature death, and should be used to initiate intensive risk factor reduction and close follow-up.” 

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Source: BMC Endocrine Disorders