Five-year mortality in patients with diabetic foot ulcer during 2009–2010 was lower than expected - 17/08/19

Doi : 10.1016/j.diabet.2019.04.010

C. Amadou ^a,^{^{1
These authors contributed equally to this work.}}, A. Carlier ^a,^b,^c,^{^{1
These authors contributed equally to this work.}}, C. Amouyal ^d, O. Bourron ^a,^b,^c, C. Aubert ^e, T. Couture ^c,^f, E. Fourniols ^g, G. Ha Van ^a, S. Rouanet ^h, A. Hartemann ^a,^b,^c,⁎
^a Diabetology department, Pitié-Salpêtrière Hospital, AP–HP, 83, boulevard de l’Hôpital, 75013 Paris, France
^b Inserm, CIC-1421, Department of Pharmacology, Pitié-Salpêtrière Hospital, AP–HP, 83, boulevard de l’Hôpital, 75013 Paris, France
^c Sorbonne Université, 91, boulevard de l’Hôpital, 75013 Paris, France
^d Inserm, Sorbonne-Université, Research Unit on Cardiovascular, Metabolic and Nutrition Diseases (UMRS-1166), Institute of Cardiometabolism and Nutrition, 91, boulevard de l’Hôpital, 75013 Paris, France
^e Department of Internal Medicine, Fribourg Hospital, Fribourg, Switzerland
^f Department of Vascular Surgery, Pitié-Salpêtrière Hospital, AP–HP, 83, boulevard de l’Hôpital, 75013 Paris, France
^g Department of Orthopedic Surgery, Pitié-Salpêtrière Hospital, AP–HP, 83, boulevard de l’Hôpital, 75013 Paris, France
^h StatEthic SASU, 73, rue Paul-Vaillant-Couturier, 92300 Levallois-Perret, France

^⁎Corresponding author at: Diabetology department, Pitié-Salpêtrière Hospital, AP–HP, 83, boulevard de l’Hôpital, 75013 Paris, France.Diabetology department, Pitié-Salpêtrière Hospital, AP–HP, 83, boulevard de l’HôpitalParis75013France

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Abstract

Aim

Mortality rates are decreasing in patients with diabetes. However, as this observation also concerns patients with diabetic foot ulcer (DFU), additional data are needed. For this reason, our study evaluated the 5-year mortality rate in patients with DFU during 2009–2010 and identified risk factors associated with mortality.

Methods

Consecutive patients who attended a clinic for new DFU during 2009–2010 were followed until healing and at 1 year. Data on mortality were collected at year 5. Multivariate Cox proportional-hazards model was used to identify mortality risk factors.

Results

A total of 347 patients were included: mean age was 65±12 years, diabetes duration was 16 [10; 27] years; 13% were on dialysis; and 7% had an organ transplant. At 5 years, 49 patients (14%) were considered lost to follow-up. Total mortality rate at 5 years was 35%, and 16% in patients with neuropathy. On multivariate analyses, mortality was positively associated with: age [hazard ratio (HR): 1.05 (1.03–1.07), P<0.0001]; duration of diabetes [HR: 1.02 (1.001–1.03], P=0.03]; PEDIS perfusion grade 2 vs. 1 [HR: 2.35 (1.28–4.29), P=0.006)]; PEDIS perfusion grade 3 vs. 1 [HR: 3.14 (1.58–6.24), P=0.001); and ulcer duration at year 1 [HR 2.09 (1.35–3.22), P=0.0009].

Conclusion

Mortality rates were not as high as expected despite the large number of comorbidities, suggesting that progress has been made in the health management of these patients. In particular, patients with neuropathic foot ulcer had a survival rate of 84% at 5 years.

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Keywords : Diabetes, Foot, Mortality, Ulcer

Abbreviations : ABI, CLI, DFU, PAOD, PEDIS