Predictors of lower-extremity amputation in patients with an infected diabetic foot ulcer

Kirsty Pickwell; Volkert Siersma; Marleen Kars; Jan Apelqvist; Karel Bakker; Michael Edmonds; Per Holstein; Alexandra Jirkovska; Edward Jude; Didac Mauricio; Alberto Piaggesi; Gunnel Ragnarson Tennvall; Heinrich Reike; Maximillian Spraul; Luigi Uccioli; Vilma Urbancic; Kristien van Acker; Jeff van Baal; Nicolaas Schaper

doi:10.2337/dc14-1598

Predictors of lower-extremity amputation in patients with an infected diabetic foot ulcer

Kirsty Pickwell, Volkert Siersma, Marleen Kars, Jan Apelqvist, Karel Bakker, Michael Edmonds, Per Holstein, Alexandra Jirkovska, Edward Jude, Didac Mauricio, Alberto Piaggesi, Gunnel Ragnarson Tennvall, Heinrich Reike, Maximillian Spraul, Luigi Uccioli, Vilma Urbancic, Kristien van Acker, Jeff van Baal, Nicolaas Schaper

95 Citationer (Scopus)

Abstract

OBJECTIVE Infection commonly complicates diabetic foot ulcers and is associated with a poor outcome. In a cohort of individuals with an infected diabetic foot ulcer, we aimed to determine independent predictors of lower-extremity amputation and the predictive value for amputation of the International Working Group on the Diabetic Foot (IWGDF) classification system and to develop a risk score for predicting amputation.

RESEARCH DESIGN AND METHODS We prospectively studied 575 patients with an infected diabetic foot ulcer presenting to 1 of 14 diabetic foot clinics in 10 European countries.

RESULTS Among these patients, 159 (28%) underwent an amputation. Independent risk factors for amputation were as follows: periwound edema, foul smell, (non)purulent exudate, deep ulcer, positive probe-to-bone test, pretibial edema, fever, and elevated C-reactive protein. Increasing IWGDF severity of infection also independently predicted amputation. We developed a risk score for any amputation and for amputations excluding the lesser toes (including the variables sex, pain on palpation, periwound edema, ulcer size, ulcer depth, and peripheral arterial disease) that predicted amputation better than the IWGDF system (area under the ROC curves 0.80, 0.78, and 0.67, respectively).

CONCLUSIONS For individuals with an infected diabetic foot ulcer, we identified independent predictors of amputation, validated the prognostic value of the IWGDF classification system, and developed a new risk score for amputation that can be readily used in daily clinical practice. Our risk score may have better prognostic accuracy than the IWGDF system, the only currently available system, but our findings need to be validated in other cohorts.

Originalsprog	Engelsk
Tidsskrift	Diabetes Care
Vol/bind	38
Udgave nummer	5
Sider (fra-til)	852-857
Antal sider	6
ISSN	0149-5992
DOI	https://doi.org/10.2337/dc14-1598
Status	Udgivet - maj 2015

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PATIENT
Patients
semrap-2015-1

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10.2337/dc14-1598

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Pickwell, K., Siersma, V., Kars, M., Apelqvist, J., Bakker, K., Edmonds, M., Holstein, P., Jirkovska, A., Jude, E., Mauricio, D., Piaggesi, A., Ragnarson Tennvall, G., Reike, H., Spraul, M., Uccioli, L., Urbancic, V., van Acker, K., van Baal, J., & Schaper, N. (2015). Predictors of lower-extremity amputation in patients with an infected diabetic foot ulcer. Diabetes Care, 38(5), 852-857. https://doi.org/10.2337/dc14-1598

Pickwell, K, Siersma, V, Kars, M, Apelqvist, J, Bakker, K, Edmonds, M, Holstein, P, Jirkovska, A, Jude, E, Mauricio, D, Piaggesi, A, Ragnarson Tennvall, G, Reike, H, Spraul, M, Uccioli, L, Urbancic, V, van Acker, K, van Baal, J & Schaper, N 2015, 'Predictors of lower-extremity amputation in patients with an infected diabetic foot ulcer', Diabetes Care, bind 38, nr. 5, s. 852-857. https://doi.org/10.2337/dc14-1598

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title = "Predictors of lower-extremity amputation in patients with an infected diabetic foot ulcer",

abstract = "OBJECTIVE Infection commonly complicates diabetic foot ulcers and is associated with a poor outcome. In a cohort of individuals with an infected diabetic foot ulcer, we aimed to determine independent predictors of lower-extremity amputation and the predictive value for amputation of the International Working Group on the Diabetic Foot (IWGDF) classification system and to develop a risk score for predicting amputation.RESEARCH DESIGN AND METHODS We prospectively studied 575 patients with an infected diabetic foot ulcer presenting to 1 of 14 diabetic foot clinics in 10 European countries.RESULTS Among these patients, 159 (28%) underwent an amputation. Independent risk factors for amputation were as follows: periwound edema, foul smell, (non)purulent exudate, deep ulcer, positive probe-to-bone test, pretibial edema, fever, and elevated C-reactive protein. Increasing IWGDF severity of infection also independently predicted amputation. We developed a risk score for any amputation and for amputations excluding the lesser toes (including the variables sex, pain on palpation, periwound edema, ulcer size, ulcer depth, and peripheral arterial disease) that predicted amputation better than the IWGDF system (area under the ROC curves 0.80, 0.78, and 0.67, respectively).CONCLUSIONS For individuals with an infected diabetic foot ulcer, we identified independent predictors of amputation, validated the prognostic value of the IWGDF classification system, and developed a new risk score for amputation that can be readily used in daily clinical practice. Our risk score may have better prognostic accuracy than the IWGDF system, the only currently available system, but our findings need to be validated in other cohorts.",

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author = "Kirsty Pickwell and Volkert Siersma and Marleen Kars and Jan Apelqvist and Karel Bakker and Michael Edmonds and Per Holstein and Alexandra Jirkovska and Edward Jude and Didac Mauricio and Alberto Piaggesi and {Ragnarson Tennvall}, Gunnel and Heinrich Reike and Maximillian Spraul and Luigi Uccioli and Vilma Urbancic and {van Acker}, Kristien and {van Baal}, Jeff and Nicolaas Schaper",

year = "2015",

month = may,

doi = "10.2337/dc14-1598",

language = "English",

volume = "38",

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journal = "Diabetes Care",

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TY - JOUR

T1 - Predictors of lower-extremity amputation in patients with an infected diabetic foot ulcer

AU - Pickwell, Kirsty

AU - Siersma, Volkert

AU - Kars, Marleen

AU - Apelqvist, Jan

AU - Bakker, Karel

AU - Edmonds, Michael

AU - Holstein, Per

AU - Jirkovska, Alexandra

AU - Jude, Edward

AU - Mauricio, Didac

AU - Piaggesi, Alberto

AU - Ragnarson Tennvall, Gunnel

AU - Reike, Heinrich

AU - Spraul, Maximillian

AU - Uccioli, Luigi

AU - Urbancic, Vilma

AU - van Acker, Kristien

AU - van Baal, Jeff

AU - Schaper, Nicolaas

PY - 2015/5

Y1 - 2015/5

N2 - OBJECTIVE Infection commonly complicates diabetic foot ulcers and is associated with a poor outcome. In a cohort of individuals with an infected diabetic foot ulcer, we aimed to determine independent predictors of lower-extremity amputation and the predictive value for amputation of the International Working Group on the Diabetic Foot (IWGDF) classification system and to develop a risk score for predicting amputation.RESEARCH DESIGN AND METHODS We prospectively studied 575 patients with an infected diabetic foot ulcer presenting to 1 of 14 diabetic foot clinics in 10 European countries.RESULTS Among these patients, 159 (28%) underwent an amputation. Independent risk factors for amputation were as follows: periwound edema, foul smell, (non)purulent exudate, deep ulcer, positive probe-to-bone test, pretibial edema, fever, and elevated C-reactive protein. Increasing IWGDF severity of infection also independently predicted amputation. We developed a risk score for any amputation and for amputations excluding the lesser toes (including the variables sex, pain on palpation, periwound edema, ulcer size, ulcer depth, and peripheral arterial disease) that predicted amputation better than the IWGDF system (area under the ROC curves 0.80, 0.78, and 0.67, respectively).CONCLUSIONS For individuals with an infected diabetic foot ulcer, we identified independent predictors of amputation, validated the prognostic value of the IWGDF classification system, and developed a new risk score for amputation that can be readily used in daily clinical practice. Our risk score may have better prognostic accuracy than the IWGDF system, the only currently available system, but our findings need to be validated in other cohorts.

AB - OBJECTIVE Infection commonly complicates diabetic foot ulcers and is associated with a poor outcome. In a cohort of individuals with an infected diabetic foot ulcer, we aimed to determine independent predictors of lower-extremity amputation and the predictive value for amputation of the International Working Group on the Diabetic Foot (IWGDF) classification system and to develop a risk score for predicting amputation.RESEARCH DESIGN AND METHODS We prospectively studied 575 patients with an infected diabetic foot ulcer presenting to 1 of 14 diabetic foot clinics in 10 European countries.RESULTS Among these patients, 159 (28%) underwent an amputation. Independent risk factors for amputation were as follows: periwound edema, foul smell, (non)purulent exudate, deep ulcer, positive probe-to-bone test, pretibial edema, fever, and elevated C-reactive protein. Increasing IWGDF severity of infection also independently predicted amputation. We developed a risk score for any amputation and for amputations excluding the lesser toes (including the variables sex, pain on palpation, periwound edema, ulcer size, ulcer depth, and peripheral arterial disease) that predicted amputation better than the IWGDF system (area under the ROC curves 0.80, 0.78, and 0.67, respectively).CONCLUSIONS For individuals with an infected diabetic foot ulcer, we identified independent predictors of amputation, validated the prognostic value of the IWGDF classification system, and developed a new risk score for amputation that can be readily used in daily clinical practice. Our risk score may have better prognostic accuracy than the IWGDF system, the only currently available system, but our findings need to be validated in other cohorts.

KW - PATIENT

KW - Patients

KW - semrap-2015-1

U2 - 10.2337/dc14-1598

DO - 10.2337/dc14-1598

M3 - Journal article

SN - 0149-5992

VL - 38

SP - 852

EP - 857

JO - Diabetes Care

JF - Diabetes Care

IS - 5

ER -

Predictors of lower-extremity amputation in patients with an infected diabetic foot ulcer

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