Exp Clin Endocrinol Diabetes
DOI: 10.1055/a-1322-4811
Article

Outcomes after Emergency Admission with a Diabetic Foot Attack Indicate a High Rate of Healing and Limb Salvage But Increased Mortality: 18-Month Follow-up Study

Erika Vainieri
1  King’s College Hospital NHS Foundation Trust, London, United Kingdom
,
Raju Ahluwalia
1  King’s College Hospital NHS Foundation Trust, London, United Kingdom
,
Hani Slim
1  King’s College Hospital NHS Foundation Trust, London, United Kingdom
,
Daina Walton
1  King’s College Hospital NHS Foundation Trust, London, United Kingdom
,
Chris Manu
1  King’s College Hospital NHS Foundation Trust, London, United Kingdom
,
Surabhi Taori
1  King’s College Hospital NHS Foundation Trust, London, United Kingdom
2  School of Immunology & Microbial Sciences, Kings College, London, United Kingdom
,
Jason Wilkins
1  King’s College Hospital NHS Foundation Trust, London, United Kingdom
,
Dean Y. Huang
1  King’s College Hospital NHS Foundation Trust, London, United Kingdom
,
Mike Edmonds
1  King’s College Hospital NHS Foundation Trust, London, United Kingdom
,
Hisham Rashid
1  King’s College Hospital NHS Foundation Trust, London, United Kingdom
,
Venu Kavarthapu
1  King’s College Hospital NHS Foundation Trust, London, United Kingdom
,
Prashanth R J Vas
1  King’s College Hospital NHS Foundation Trust, London, United Kingdom
3  Institute of Diabetes, Endocrinology and Obesity, King’s Health Partners, London, United Kingdom
› Author Affiliations
Funding: The authors received no financial support for the research, authorship, and preparation of this manuscript.

Abstract

Aim The diabetic foot attack (DFA) is perhaps the most devastating form of diabetic foot infection, presenting with rapidly progressive skin and tissue necrosis, threatening both limb and life. However, clinical outcome data in this specific group of patients are not available.

Methods Analysis of 106 consecutive patients who underwent emergency hospitalisation for DFA (TEXAS Grade 3B or 3D and Infectious Diseases Society of America (IDSA) Class 4 criteria). Outcomes evaluated were: 1) Healing 2) major amputation 3) death 4) not healed. The first outcome reached in one of these four categories over the follow-up period (18.4±3.6 months) was considered. We also estimated amputation free survival.

Results Overall, 57.5% (n=61) healed, 5.6% (n=6) underwent major amputation, 23.5% (n=25) died without healing and 13.2% (n=14) were alive without healing. Predictive factors associated with outcomes were: Healing (age<60, p=0.0017; no Peripheral arterial disease (PAD) p= 0.002; not on dialysis p=0.006); major amputation (CRP>100 mg/L, p=0.001; gram+ve organisms, p=0.0013; dialysis, p= 0.001), and for death (age>60, p= 0.0001; gram+ve organisms p=0.004; presence of PAD, p=0.0032; CRP, p=0.034). The major amputation free survival was 71% during the first 12 months from admission, however it had reduced to 55.4% by the end of the follow-up period.

Conclusions In a unique population of hospitalised individuals with DFA, we report excellent healing and limb salvage rates using a dedicated protocol in a multidisciplinary setting. An additional novel finding was the concerning observation that such an admission was associated with high 18-month mortality, almost all of which was after discharge from hospital.



Publication History

Received: 11 August 2020
Received: 10 November 2020

Accepted: 25 November 2020

Publication Date:
22 December 2020 (online)

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