Lin C, Liu J, Sun H, et al.
PloS one. Date of publication 2020 Sep 16;volume 15(9):e0239236.
1. PLoS One. 2020 Sep 16;15(9):e0239236. doi: 10.1371/journal.pone.0239236.
eCollection 2020.
Risk factors for lower extremity amputation in patients with diabetic foot
ulcers: A meta-analysis.
Lin C(1), Liu J(2), Sun H(2).
Author information:
(1)Department of Endocrinology and Metabolism, Fujian Medical University Xiamen
Humanity Hospital, Xiamen, Fujian Province, People's Republic of China.
(2)Department of Vascular Surgery, Zhongshan Hospital Affiliated to Xiamen
University, Xiamen, Fujian Province, People's Republic of China.
PURPOSE: A considerable number of diabetic foot ulcer (DFU) patients require
amputation every year, which worsens their quality of life, aggravates the social
burden, and shortens their life expectancy. Considering these negative effects,
it is important to explore the relative risk factors affecting amputation in DFU
patients.
METHODS: The PubMed, SCIE and Embase databases were comprehensively searched for
prospective or retrospective studies published before October 31, 2019. All
English language studies involving DFU patients were included, and RevMan 5.3
software was used to analyse the data.
RESULTS: This meta-analysis includes 21 studies involving 6505 participants,
including 2006 patients who required a lower limb amputation. The following
variables were associated with an increased risk of amputation: male sex (odds
ratios (OR) = 1.30, 95% confidence interval (CI) = 1.16~1.46, P<0.00001), smoking
history (OR = 1.19, 95% CI = 1.04~1.35, P = 0.009), a history of foot ulcers (OR
= 2.48, 95% CI = 2.00~3.07, P<0.00001), osteomyelitis (OR = 3.70, 95% CI =
3.02~4.53, P<0.00001), gangrene (OR = 10.90, 95% CI = 5.73~20.8, P<0.00001), a
lower body mass index (mean difference IV (MD) = -0.88, 95% CI = -1.30~-0.47,
P<0.0001), and a higher white blood cell count (MD = 2.42, 95% CI = 2.02~2.82,
P<0.00001). However, age (MD = 1.24, 95% CI = -0.45~2.93, P = 0.15), type of
diabetes (OR = 0.96, 95% CI = 0.61~1.52, P = 0.86), hypertension (OR = 1.19, 95%
CI = 0.96~1.47, P = 0.12), and HbA1c level (MD = 0.02, 95% CI = -0.28~0.33, P =
0.87) were not associated with amputation in patients with DFU.
CONCLUSIONS: Our meta-analysis identified several risk factors for amputation in
DFU patients, including the male sex, a smoking history, a history of foot
ulcers, osteomyelitis, gangrene, a lower body mass index, and a higher white
blood cell count. Once gangrene occurs, the risk of amputation rapidly increases.
DOI: 10.1371/journal.pone.0239236
PMID: 32936828
Conflict of interest statement: The authors have declared that no competing
interests exist.
