Predictors of outcome in patients with diabetic foot ulcer at Assiut university hospital

ABSTRACT

Prediction of diabetic foot ulcer outcome may be helpful for clinicians in optimizing and individualizing management strategy. The aim of the present study was to examine the possibility of predicting the outcome of patients with diabetic foot ulcers by using easily assessed clinical and laboratory parameters at baseline, In this study data were collected prospectively in 107 patients with diabetic foot ulcer examined and followed between March 2009 and March 2012 in the Diabetic clinic at Assiut university hospital and were used to evaluate potential predictors of ulcer non-healing, after a follow-up period for a maximum one year. After 1 year of follow-up, 29.9% of the patients showed non-healed ulcers. Baseline predictors of ulcer non-healing in the whole study population were duration of diabetes > 10 years [P<0.0001], negative neuropathic symptoms [ie loss of sensation in the foot] [P<0.0001], colour changes in the foot [P<0.0001], duration of ulcer [>3 months] [P<0.0001], HbA1c [> 12%] and Texas classification class D Older age [P<0.004], presence of hypertension [P< 0. 02] nephropathy [P< 0.005] ,smoking, presence of PAD as ABI < 0.9 [P< 0.02] and absent pedal pulses [P<0.0001] ,ulcer size [> 5 cm[2]]., ulcer depth grade 3, increase total white blood cell count, ,decreased serum albumin and decreased hemoglobin levels were also associated with increased risk of unhealing. Duration of diabetes > 10 years [P<0.0001], negative neuropathic symptoms [ie loss of sensation in the foot] [P<0.01], colour changes in the foot due to presence of PAD [P<0.01], duration of ulcer > 3 months [P<0.04], HbA1c > 12% [P<0.001] and Texas classification stage D [P<0.01] were considered a major independent predictors of unhealing of diabetic foot ulceration