1, 3 and 5 year survival after a diabetic foot ulcer is 80%, 69% and 29%

Congratulations to Brennan and coworkers for these sobering data.

Perhaps the reason these sobering data are so sobering is because the “hole” is a window on the “whole”. In other words, the ulcer on the foot is likely a better predictor than any of the other end organ diseases because it is an amalgam of all of those complications in one place.

Diabetic foot ulcer severity predicts mortality among veterans with type 2 diabetes

Meghan B. Brennana, b, c, , , Timothy M. Hessa, b, Brian Bartlec, Jennifer M. Cooperd, Jonathan Kangb, Elbert S. Huangc, d, Maureen Smitha, Min-Woong Sohnc, e, Christopher Crnicha, b

Aim

Diabetic foot ulcers are associated with an increased risk of death. We evaluated whether ulcer severity at presentation predicts mortality.

Methods

Patients from a national, retrospective, cohort of veterans with type 2 diabetes who developed incident diabetic foot ulcers between January 1, 2006 and September 1, 2010, were followed until death or the end of the study period, January 1, 2012. Ulcers were characterized as early stage, osteomyelitis, or gangrene at presentation. Cox proportional hazard regression identified independent predictors of death, controlling for comorbidities, laboratory parameters, and healthcare utilization.

Results

66,323 veterans were included in the cohort and followed for a mean of 27.7 months: 1-, 2-, and 5-year survival rates were 80.80%, 69.01% and 28.64%, respectively. Compared to early stage ulcers, gangrene was associated with an increased risk of mortality (HR 1.70, 95% CI 1.57–1.83, p < 0.001). The magnitude of this effect was greater than diagnosed vascular disease, i.e., coronary artery disease, peripheral arterial disease, or stroke.

Conclusion

Initial diabetic foot ulcer severity is a more significant predictor of subsequent mortality than coronary artery disease, peripheral arterial disease, or stroke. Unrecognized or under-estimated vascular disease and/or sepsis secondary to gangrene should be explored as possible causal explanations.

 

Thanks as always to Dr. Khurram Khan for spotting this intriguing study first.

 

Survival after DFU.png

Source: Diabetic foot ulcer severity predicts mortality among veterans with type 2 diabetes

David G. Armstrong

Dedicated to amputation prevention, wound healing, diabetic foot, biotechnology and the intersection between medical devices and consumer electronics.

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