Predictive Factors of Lower Limb Amputation in Diabetic Foot Ulcer Patients in Thasala Hospital, Nakorn Si Thammarat

Abstract

Background: Diabetes is a non-communicable disease that poses a significant public health problem. Management of diabetes focuses on controlling blood sugar levels and monitoring for complications, particularly foot ulcers are a serious complication and can lead to diabetic foot infections, which may progress to amputation or even death.

Objective: The aim of study is to identify clinical characteristics of diabetic foot ulcer patients for predicting the likelihood of undergoing toe or limb amputation.

Material and Methods: A retrospective prognostic study included all patients with diabetic foot ulcers at Thasala hospital from October 1, 2017 to September 30, 2023. Patients were divided into amputation and non-amputation. Demographic data and clinical factors were collected and analyzed to identify predictors associated with toe or limb amputation.

Results: A total of 235 patients with infected diabetic foot ulcers, 86 patients (36.6%) underwent toe or limb amputation. The study identified several significant factors: comorbid conditions such as hypertension (p=0.024), hyperlipidemia (p=0.016), presence of claw toe deformity (p=0.043), hallux valgus deformity (p<0.001), ABI <0.8 (p<0.001), osteomyelitis (p<0.001), laboratory findings with WBC >15,000 (p<0.001), hemoglobin ≤10 (p=0.003), and HbA1c ≥9 (p=0.045) were significantly associated with the likelihood of amputation (p<0.05).

Conclusions: Diabetic patients with clinical factors such as hypertension, hyperlipidemia, foot deformity, ABI <0.8, osteomyelitis, WBC >15,000, hemoglobin ≤10, and HbA1c ≥9 may be used to predict the likelihood of requiring amputation of a toe or limb in diabetic foot ulcer patients. This can help in recognizing the severity of disease, prioritizing treatment, and providing relevant information to patients and their families.