Predictors of Lower-Extremity Amputation in Patients With an Infected Diabetic Foot Ulcer

Kristy Pickwell, Volkert Siersma, Marleen Kars, Jan Apelqvist, Karel Bakker, Michael Edmonds, Per Holstein, Alexandra Jirkovská, Edward Jude, Didac Mauricio, Alberto Piaggesi, Gunnel Ragnarson Tennvall (+7 others)
2015 Diabetes Care  
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
more » ... atients 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 probing 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).
doi:10.2337/dc14-1598 pmid:25665817 fatcat:oyswdswrpjdjxke7vrmqyszoge