Risk Factors For Major Amputation In Diabetic Foot Patients

Abstract

Objectives : this study to identify the clinical and laboratory factors associated with the risk factors of major amputation in diabetic foot patients.
Patents, materials and method: this is cross sectional study carried out in Basra general hospital between November 2013 to  June 2016. 100 diabetic foot patients evaluated for duration of the illness, type of diabetes, socioeconomic state, smoking history, previous amputation, retinopathy, nephropathy, neuropathy, cardiac disease, foot deformities. The foot ulcers were classified according to Wagner classification, foot ischemia was assessed by Doppler study, baseline laboratory investigations done include Hb%, WBC, ESR, Fasting blood sugar, Hb A1c, blood urea, serum creatinine, serum albumin, ECG, Chest x-ray.
Results: number of risk factors found to be associated with risk of major amputation in diabetic foot patient include male sex, age>60 years, nephropathy, retinopathy, neuropathy, foot deformity, previous amputation, duration of diabetes >15 years, low socioeconomic state, Hb<10gm/dl, ESR>80, Hb A1c>8%, serum albumin<2.5gm/dl, Doppler score>6, high Wagner score.
Conclusion:

1. 
   Wagner grade 4 and 5 are the major independent risk factor for major amputation.
   


2. 
   WBC count is poor predictor for the severity of diabetic foot.
   


3. 
   Scoring system can be arranged for each patient according which appropriate decision can be made amputation and conservative treatment.
   

 
Table 1: Diabetic Foot Scoring System




Number


Risk factor


score




1


Male sex


1




2


Age > 60 year


1




3


DM duration > 16year


1




4


Wagner grade 4 and 5


One for each




5


Smoking


1




6


Low socioeconomic state


1




7


Neuropathy


1




8


Nephropathy


1




9


Retinopathy


1




10


Cardiac disease


1




11


Previous amputation


1




12


Foot deformities


1




13


Hb<10gm/dl


1




14


Albumin level<2.5gm/dl


1




15


Fasting blood sugar


1




16


Doppler score


1




17


ESR>80


1




18


Doppler score >6


1




19


Total score


23