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Survival and Associated Risk Factors in Patients With Diabetes and Amputations Caused by Infectious Foot Gangrene


Survival and Associated Risk Factors in Patients With Diabetes and Amputations Caused by Infectious Foot Gangrene

Yu-Yao Huang et al. J Foot Ankle Res.


Background: Infectious gangrene of the foot is a serious complication of diabetes that usually leads to a certain level of lower-extremity amputation (LEA). Nevertheless, the long-term survival and factors associated with mortality in such patients have yet to be elucidated.

Methods: A total of 157 patients with type 2 diabetes who received treatment for infectious foot gangrene at a major diabetic foot center in Taiwan from 2002 to 2009 were enrolled, of whom 90 had major LEAs (above the ankle) and 67 had minor LEAs (below the ankle). Clinical data during treatment were used for the analysis of survival and LEA, and survival was tracked after treatment until December 2012.

Results: Of the 157 patients, 109 died, with a median survival time of 3.12 years and 5-year survival rate of 40%. Age [hazard ratio 1.04 (95% confidence interval 1.01-1.06)], and major LEA [1.80 (1.05-3.09)] were independent factors associated with mortality. Patients with minor LEAs had a better median survival than those with major LEAs (5.5 and 1.9 years, respectively, P < 0.01). An abnormal ankle-brachial index was an independent risk factor [odds ratio 3.12 (95% CI 1.18-8.24)] for a poor outcome (major LEA) after adjusting for age, smoking status, hypertension, major adverse cardiac events, and renal function.

Conclusions: Efforts to limit amputations below the ankle resulted in better survival of patients with infectious foot gangrene. An abnormal ankle-brachial index may guide physicians to make appropriate decisions with regards to the amputation level.

Keywords: Diabetes; Infectious foot gangrene; Lower-extremity amputation; Survival.

Conflict of interest statement

The Institutional Review Board of Chang Gung Memorial Hospital approved this study (no. 104-1401B).Not applicable.The authors declare that they have no competing interests.Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.


Fig. 1
Fig. 1
Adjusted survival curve from a Cox proportional hazard model according to limb amputation status and renal function status. a Compared to the minor LEA group, the adjusted hazard ratio for mortality was 1.80 (95% CI 1.05–3.09, P = 0.03) for those with major LEAs. b Compared to the normal renal function group, the adjusted hazard ratio for mortality was 0.87 (95% CI 0.48–1.59, P = 0.66) for those with CKD and 2.09 (95% CI 0.99–4.41, P = 0.05) for those undergoing dialysis. Covariates included continuous variables of age, diabetes duration, and HbA1c; and categorical variables of hypertension, major adverse cardiac events, renal function, ABI value and limb amputation status

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