Prediction of outcome in individuals with diabetic foot ulcers: focus on the differences between individuals with and without peripheral arterial disease. The EURODIALE Study

By L. Prompers, N. Schaper, J. Apelqvist, M. Edmonds, E. Jude, D. Mauricio, L. Uccioli, V. Urbančič, K. Bakker, P. Holstein and 10 more. Diabetologia, 2008

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Aims/hypothesisOutcome data on individuals with diabetic foot ulcers are scarce, especially in those with peripheral arterial disease (PAD). We therefore examined the clinical characteristics that best predict poor outcome in a large population of diabetic foot ulcer patients and examined whether such predictors differ between patients with and without PAD.MethodsAnalyses were conducted within the EURODIALE Study, a prospective cohort study of 1,088 diabetic foot ulcer patients across 14 centres in Europe. Multiple logistic regression modelling was used to identify independent predictors of outcome (i.e. non-healing of the foot ulcer).ResultsAfter 1 year of follow-up, 23% of the patients had not healed. Independent baseline predictors of non-healing in the whole study population were older age, male sex, heart failure, the inability to stand or walk without help, end-stage renal disease, larger ulcer size, peripheral neuropathy and PAD. When analyses were performed according to PAD status, infection emerged as a specific predictor of non-healing in PAD patients only.Conclusions/interpretationPredictors of healing differ between patients with and without PAD, suggesting that diabetic foot ulcers with or without concomitant PAD should be defined as two separate disease states. The observed negative impact of infection on healing that was confined to patients with PAD needs further investigation.

Subfields: Endocrinology, Diabetes and Metabolism, Surgery

View Paper: https://www.semanticscholar.org/paper/cdc08faa67acdca32c79eeb35dd20bb1bc18b6d8

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In Endocrinology, Diabetes and Metabolism

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Citations in the corpus

2012 infectious diseases society of america clinical practice guideline for the diagnosis and treatment of diabetic foot infections. (2013, neutral): “their foot ulcer; among independent baseline predictors of nonhealing, PAD was key, and infection was a predictor only in patients with PAD [14].”
The Society for Vascular Surgery Lower Extremity Threatened Limb Classification System: risk stratification based on wound, ischemia, and foot infection (WIfI). (2014, background): “8 are at lower risk for amputation and unlikely to require revascularization to achieve healing.(34,44,54) In these patients, wound and infection severity are the major determinants of amputation risk.”
Guidelines on the diagnosis and treatment of foot infection in persons with diabetes (IWGDF 2019 update) (2020, background): “presence of limb ischemia increases the risk of an ulcer becoming infected(4,14-16) and adversely affects the outcome of infection.(4,17,18) Foot ulcers in persons with diabetes often become chronic, related to increased biomechanical stress, hyperglycaemia and its metabolic consequences, persistent”
Diabetes and Wound Angiogenesis (2017, background): “Numerous studies have highlighted the importance of adequate vascular sufficiency and vessel proliferation in tissue repair and the lack thereof in diabetic wound healing [8].”
The management of diabetic foot: A clinical practice guideline by the Society for Vascular Surgery in collaboration with the American Podiatric Medical Association and the Society for Vascular Medicine. (2016, methodology): “Therefore, after drainage of infection, revascularization should be strongly considered if a diabetic foot wound does not promptly respond to standard wound care in accordance with the SVS WIfI system.(6,172-174)”
MICE: Multivariate Imputation by Chained Equations in R (2011, background): “…et al. 2009), epidemiology (Cummings et al. 2006; Hindorff et al. 2008; Mueller et al. 2008; Ton et al. 2009), endocrinology (Rouxel et al. 2004; Prompers et al. 2008), infectious diseases (Cottrell et al. 2005; Walker et al. 2006; Cottrell et al. 2007; Kekitiinwa et al. 2008; Nash et al. 2008;…”
2016 AHA/ACC Guideline on the Management of Patients With Lower Extremity Peripheral Artery Disease (2016, background): “The EuroDIALE (European Study Group on Diabetes and the Lower Extremity) study demonstrated that the presence of both PAD and foot infection conferred a nearly 3-fold higher risk of leg amputation than either infection or PAD alone (228).”
Global vascular guidelines on the management of chronic limb-threatening ischemia (2019, background): “The likelihood and duration of healing are also determined by the presence of concomitant infection and ischemia.(192)”