Page 5 - Vasoclick emagazine Issue2

Four major factors associated with a
Materials and methods
The retrospective cohort study enrolled adult
patients presenting with acute DFI at the
Tampere University Hospital during 2010
-2014.
6,7
patient-related
Following
collected from the hospital records:
Patient demographics (age and gender)
Registered diagnoses (ischemic heart disease,
chronic obstructive pulmonary disease, con-
gestive heart failure and dyslipidemia, microbi-
ological and clinical chemistry findings, surgi-
cal revisions and amputations, open and endo-
vascular revascularization procedures, wound
status, and the length of hospital stay).
Vasoclick, Edition 2 information 6 was
Conclusion
Patients with DFI have high morbidity and
poor survival outcomes despite advanced
treatment resources.
6
High CRP levels are associated with a
reduced AFS.
6
Ischemic infections in deep wounds with
high CRP levels suggest severity of the
disease and must be prevented early. 6 et al. A comparison of necrotising fasciitis in diabetics
A major amputation is a strong predictor of
death in patients with DFI.
6
Thus, early identification and treatments of
DFI are critical to improve both the AFS and
OS.
6
References:
1) Armstrong DG, Swerdlow MA, Armstrong AA, Conte MS,
Padula WV, Bus SA. Five year mortality and direct costs of
care for people with diabetic foot complications are
comparable to cancer. J Foot Ankle Res. 2020;13:16. doi:
10.1186/s13047-020-00383-2
2) Ndosi M, Wright-Hughes A, Brown S, Backhouse M,
Lipsky BA, Bhogal M, et al. Prognosis of the infected
diabetic foot ulcer: a 12-month prospective observational
study. Diabet Med. 2018; 35:78–88. doi:
10.1111/dme.13537
3) Huang Y-Y, Lin C-W, Yang H-M, Hung S-Y, Chen I-W.
Survival and associated risk factors in patients with
diabetes and amputations caused by infectious foot
gangrene. J Foot Ankle Res. 2018; 11:1. doi:
10.1186/s13047-017-0243-0
4) Raspovic KM, Wukich DK. Self-reported quality of life
and diabetic foot infections. J Foot Ankle Surg. 2014;
53:716–9. doi: 10.1053/j.jfas.2014.06.011
5) Peters EJ, Childs MR, Wunderlich RP, Harkless LB,
Armstrong DG, Lavery LA. Functional status of persons
with diabetesrelated lower-extremity amputations.
Diabetes Care. 2000; 24:1799-804. doi:
10.2337/diacare.24.10.1799
6) Vuorlaakso M, Kiiski J, Salonen T, Karppelin M,
Helminen M, Kaartinen I. Major Amputation Profoundly
Increases Mortality in Patients With Diabetic Foot
Infection. Front Surg. 2021;8:655902. Published 2021 Apr
30.doi:10.3389/fsurg.2021.655902
improved by revascularization in patients with
significantly shorter OS
6
ischemic infection. Thus, timely management of
6
ischemic wound and early access to vascular
Major amputation(s) during hospitaliza-
CI
tion
6.673;
HR
(P<0.001;
surgery for limb salvage in diabetic patients is
2.836–15.700)
strongly recommended.
6
Wound ischemia: due to an infected
ulcer [(vs. non-ischemic wound; P=0.046;
e) Infection
HR 1.598; CI 1.008–2.532)
1) Indicative of severe infection, high CRP
The LRINEC -score had no effect on the OS or
Overall 324 patients were enrolled (237 males,
Age: over 67 years (P<0.001; HR 1.055;
levels were found to be associated with a
87 females; mean age, 66.8 years, SD 12.8)
AFS.
6
CI 1.035–1.076)
worse AFS.
with 404 periods of hospitalization.
6
2) AFS was also associated with a deep wound
Impaired renal functions: eGFR under
60 ml/min (P<0.001; HR 0.989; CI
(penetrating to the bone or joint) and high
Fasciitis score (LRINEC score):
0.982–0.995)
blood leukocytes.
6
It is a sensitive scoring system to identify
3) Long-lasting and multiple foot ulcers were
necrotizing fasciitis and distinguish it from other
also associated with a worse outcome as
soft tissue infections. An LRINEC score of >8
8
acute infection can undergo a minor amputation
reported previously.
2, 6
has been found to be sensitive for patients with
to restrict the infection, and this way a major
diabetes.
9
amputation can be avoided, saving both limb and
c) Survival of patients with DFI
The study therefore emphasized on the
life of the patient.
The present study showed that survival of
importance of early detection and treatment of
The present study assessed the utility of LRINEC
patients after a DFI was poor within one-year
the infection for diabetic foot ulcers.
6
score to diagnose severe DFI and a poor
d) Effect of revascularization
(81.2%), and almost 50% of patients died within
prognosis. LRINEC score with a cutoff of >8 was
The AFS was greatly reduced in patients with
5-years after a DFI. The risk of death was almost
6
f) Hypertension
chosen to identify necrotizing fasciitis.
6
ischemic wounds. 16.1% of the cases had
six-fold after the infection among patients that
The study demonstrated that use of a
revascularization within 1 month of admission
amputation
underwent
hypertensive medication was associated with an
A specialist in plastic surgery staged the wounds
and in most cases within 1 week.
6
infections but treated without amputation. After
increased AFS, however the observation requires
according to the University of Texas Staging
a 5-year follow-up, only 1 of 12 patients (8.3%)
further validation.
6
System for Diabetic Foot Ulcers (UT scale).
6,10
Revascularization
or
procedure
(open
survived.
6
endovascular) had no effect on survival of
The Laboratory Risk Indicator for Necrotizing a) Patient characteristics 6 b) The LRINEC-score than those with Therefore, a diabetes patient presenting with an patients, however, AFS was significantly
04
7) LaaksoM, Kiiski J, KarppelinM, HelminenM, Kaartinen I.
Pathogens causing diabetic foot infection and the
reliability of the superficial culture. Surg Infect. 2020. doi:
10.1089/sur.2020.072.
8) Wong C-H, Khin L-W, Heng K-S, Tan K-C, Low C-O. The
LRINEC (Laboratory Risk Indicator for Necrotizing
Fasciitis) score: a tool for distinguishing necrotizing
fasciitis from other soft tissue infections. Crit Care Med.
2004; 32:1535–41. doi:
10.1097/01.CCM.0000129486.35458.7D
9)Tan JH, Koh BTH, Hong CC, Lim SH, Liang S, Chan GEH,
and non-diabetics: a review of 127 patients. Bone Joint J.
(2016) 98-B:1563–8. doi:
10.1302/0301-620X.98B11.37526
10) Lavery LA, Armstrong DG, Harkless LB. Classification
of diabetic foot wounds. J Foot Ankle Surg. 1996; 35:528–
31. doi: 10.1016/S1067-2516(96)80125-6