Background: Diabetic foot ulcers (DFU) may cause significant morbidity and lower extremity amputation (LEA) compared to the general population. The purpose of the present study was to quantify the risk factors of subsequent amputation in hospitalized Diabetic foot ulcers (DFU) patients.

Methods: We performed a hospital-based, case-control study of 94 DFU patients with LEA and 94 control DFU patients without LEA, the control subjects were matched to cases in respect to age, sex, and nutritional status, with ratio of 1:1. This study was conducted in Derna Teaching Hospital between January 2016 and December 2018, patients’ demographical data and all risk factors-related information were collected from clinical records using pre-designed format, using (LEA) as the outcome variable, we calculated odds ratios (ORs) and 95% confidence intervals (CIs) by logistic regression, which used to assess the independent effect of selected risk factors associated with LEA, the data were analyzed in SPSS version 21.

Results: There were 94 case-control pairs, all of which were diagnosed with type 2 diabetes mellitus, seven potential independent variables show a promise of influence, the latter being defined as p50.15 upon univariate analysis, multivariable logistic regression identified levels of HbA1c 8% (OR 20.47, 95% CI 3.12-134.31; p-0.002), presence of peripheral arterial disease (PAD) (OR 12.97, 95% CI 3.44-48.88; pB0.001), hypertriglyceridemia (OR 5.58, 95% CI 1.74-17.91; p-0.004), and hypertension (OR 3.67, 95% CI 1.14-11.79; p-0.028) as the independent risk factors associated with subsequent lower extremity amputation in Diabetic foot ulcers.

Conclusions: Several risk factors for LEA were identified, we found that HbA1c >8%, PAD, hypertriglyceridemia, and hypertension have been recognized as the predictors of LEA in this study, good glycemic control, active investigation against PAD, and management of comorbidities such as hypertriglycemia and hypertension are considered important to reduce amputation risk.

Keywords: diabetic foot ulcers; hospitalized patients; risk factors; amputation

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Dr Abdulbassit M.Alshallwi

Associated Professor, Department of Surgery

Faculty of Medicine- Omar Almukhtar University