Skip to main page content
Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
, 6, 29629

Risk Factors for Lower Extremity Amputation in Patients With Diabetic Foot Ulcers: A Hospital-Based Case-Control Study


Risk Factors for Lower Extremity Amputation in Patients With Diabetic Foot Ulcers: A Hospital-Based Case-Control Study

Tjokorda Gde Dalem Pemayun et al. Diabet Foot Ankle.


Background: Diabetic foot ulcers (DFU) may cause significant morbidity and lower extremity amputation (LEA) due to diabetic foot problems can occur more often compared to the general population. The purpose of the present study was to use an epidemiological design to determine and to quantify the risk factors of subsequent amputation in hospitalized DFU patients.

Methods: We performed a hospital-based, case-control study of 47 DFU patients with LEA and 47 control DFU patients without LEA. The control subjects were matched to cases in respect to age (±5 years), sex, and nutritional status, with ratio of 1:1. This study was conducted in Dr. Kariadi General Hospital Semarang between January 2012 and December 2014. Patients' demographical data and all risk factors-related information were collected from clinical records using a short structural chart. Using LEA as the outcome variable, we calculated odds ratios (ORs) and 95% confidence intervals (CIs) by logistic regression. Univariate and stepwise logistic regression analyses were used to assess the independent effect of selected risk factors associated with LEA. The data were analyzed in SPSS version 21.

Results: There were 47 case-control pairs, all of which were diagnosed with type 2 diabetes mellitus. Seven potential independent variables show a promise of influence, the latter being defined as p≤0.15 upon univariate analysis. Multivariable logistic regression identified levels of HbA1c ≥8% (OR 20.47, 95% CI 3.12-134.31; p=0.002), presence of peripheral arterial disease (PAD) (OR 12.97, 95% CI 3.44-48.88; p<0.001), hypertriglyceridemia (OR 5.58, 95% CI 1.74-17.91; p=0.004), and hypertension (OR 3.67, 95% CI 1.14-11.79; p=0.028) as the independent risk factors associated with subsequent LEA in DFU.

Conclusions: Several risk factors for LEA were identified. We found that HbA1c ≥8%, PAD, hypertriglyceridemia, and hypertension have been recognized as the predictors of LEA in this study. Good glycemic control, active investigation against PAD, and management of comorbidities such as hypertriglyceridemia and hypertension are considered important to reduce amputation risk.

Keywords: amputation; diabetic foot ulcers; hospitalized patients; risk factors.

Similar articles

See all similar articles

Cited by 17 PubMed Central articles

See all "Cited by" articles


    1. Djokomoeljanto R. Tinjauan umum tentang kaki diabetes. In: Djokomoeljanto R, Darmono, Suhartono T, editors. Kaki diabetik: Patogenesis dan penatalaksanaan. Semarang: Diponegoro University; 1997. pp. 1–10.
    1. Reiber GE. The epidemiology of diabetic foot problems. Diabetic Med. 1996;13:6–11. - PubMed
    1. Thewjitcharoen Y, Krittiyawong S, Porramatikul S, Parksook W, Chatapat L, Watchareejirachot O, et al. Outcomes of hospitalized diabetic foot patients in a multi-disciplinary team setting: Thailand's experience. J Clin Transl Endocrinol. 2014;1:187–91. - PMC - PubMed
    1. van Houtum WH. Diabetes related lower extremity amputations. Amsterdam, The Netherland: Vrije University; 1998. Master dissertation.
    1. Abbas ZG. Reducing diabetic limb amputations in developing countries. Expert Rev Endocrinol Metab. 2015;10:425–34. - PubMed

LinkOut - more resources