Meta-Analysis of Risk Factors for Lower Extremity Amputation in Diabetes Mellitus Patients with Foot Ulcers

Authors

  • Anissa Eka Septiani Masters Program in Public Health, Universitas Sebelas Maret
  • Setyo Sri Rahardjo Faculty of Medicine, Universitas Sebelas Maret
  • Hanung Prasetya Study Program of Acupuncture, School of Health Polytechnics, Ministry of Health, Surakarta

Abstract

Background: Diabetic foot ulcer is a compli­cation of diabetes mellitus which costs high, takes long wound care, increases mortality, morbidity and causes non-traumatic amputa­tion. There are risk factors that are thought to be the cause of lower limb amputation in diabetic foot ulcers, namely peripheral artery disease, hypertension and gender. This study aims to estimate the influence of peripheral artery disease, hypertension and gender on the risk of lower limb amputation in diabetes mellitus patients with leg ulcers.

Subjects and Method: Meta-analysis studies and systematic reviews were applied to this study using electronic databases of Pubmed, Scopus, Google Scholar, and Springer Link. The keywords to search for articles are as follows: "diabetic foot", "lower limb amputation", "low­er extremity amputation", "risk factor", "predic­tor", "cohort", "retrospective", "adjusted odds ratio". Articles were collected using PRISMA diagrams, and analyzed using the Review Manager 5.3 application.

Results: Meta-analysis of 9 cohort articles of diabetic foot ulcer patients with peripheral artery disease (aOR= 2.46; 95% CI= 1.70 - 3.55; p<0.01); Meta-analysis of 8 cohort articles, diabetic foot ulcer patients with hypertension (aOR= 1.05; 95% CI= 0.66 - 1.68; p= 0.83); Meta-analysis of 9 cohort articles of male diabetic foot ulcer patients (aOR= 1.60; 95% CI= 1.32 - 1.94; p<0.01); Peripheral artery disease, hypertension and male gender are risk factors that can increase the incidence of lower limb amputation.

Conclusion: Peripheral artery disease, hypertension and male gender are risk factors that can increase the incidence of lower limb amputation.

Keywords: Peripheral artery disease, diabetic foot ulcer, lower limb amputation

Correspondence: Anissa Eka Septiani. Masters Program in Public Health. Universitas Sebelas Maret. Jl. Ir. Suta­mi 36A, Surakarta 57126, Central Java,. Email: sanissaeka@gmail.com. Mobile: 08951­464­6458.

Indonesian Journal of Medicine (2020), 05(04): 343-355
https://doi.org/10.26911/theijmed.2020.05.04.10.

 

References

Acar E, Kacıra BK (2017). Predictors of lower extremity amputation and re-amputation associated with the dia-betic foot. J Foot Ankle Surg, 56(6): 1218–1222. https://doi.org/10.1053/-j.jfas.2017.06.004.

Aiello A, Anichini R, Brocco E, Caravaggi C, Chiavetta A, Cioni R, et al. (2014). Treatment of peripheral arterial disease in diabetes: a consensus of the Italian Societies of Diabetes (SID, AMD), Radiology (SIRM) and Vas-cular Endovascular Surgery (SICVE). Nutr Metab Cardiovasc Dis. 24(4): 355–369. https://doi.org/10.1016/j.-numecd.2013.12.007.

Al-Mahroos F, Al-Roomi K (2007). Diabetic neuropathy, foot ulceration, peripheral vascular disease and potential risk factors among patients with diabetes in Bahrain: a nationwide primary care diabetes clinic-based study. Ann Saudi Med, 27(1): 25–31. https://doi.-org/10.5144/0256-4947.2007.25.

Yıldız PA, Özdil T, Dizbay M, Tunçcan OG, Hızel K (2018). Peripheral arterial disease increases the risk of multi-drug-resistant bacteria and amputa-tion in diabetic foot infections. Turk J Med Sci. 48(4): 845–850. https://-doi.org/10.3906/sag-1803-217.

Barnes JA, Eid MA, Creager MA, Goodney PP (2020). Epidemiology and risk of amputation in patients with diabetes melitus and peripheral artery disease. Arterioscler Thromb Vasc Biol, 40(8): 1808–1817. doi:10.1161/atvbaha.120.-314595.

Beaney AJ, Nunney I, Gooday C, Dhatariya K (2016). Factors determining the risk of diabetes foot amputations – A re-trospective analysis of a tertiary dia-betes foot care service. Diabetes Res Clin Pract, 114: 69–74. doi:10.1016/-j.diabres.2016.02.001.

Budiman-Mak E, Epstein N, Brennan M, Stuck R, Guihan M, Huo Z, Emanuele N, Sohn MW (2016). Systolic blood pressure variability and lower extre-mity amputation in a non-elderly po-pulation with diabetes. Diabetes Res Clin Pract, 114: 75–82. https://doi.org/10.1016/j.diabres.2016.01.010.

Bruun C, Siersma V, Guassora AD, Holstein P, de Fine Olivarius N (2013). Ampu-tations and foot ulcers in patients newly diagnosed with type 2 diabetes mellitus and observed for 19 years. The role of age, gender and comorbidity. Diabet Med. 30(8): 964–972. https://doi.org/10.1111/dme.12196

Chaturvedi N, Stevens LK, Fuller JH, Lee ET, Lu M (2001). Risk factors, ethnic differences and mortality associated with lower-extremity gangrene and amputation in diabetes. The WHO Multinational Study of Vascular Dise-ase in Diabetes. Diabetologia. 44(2): S65–S71. https://doi.org/10.1007/p-l00002941.

Jeon BJ, Choi HJ, Kang JS, Tak MS, Park ES (2016). Comparison of five systems of classification of diabetik foot ulcers and predictive factors for amputation. Int Wound J, 14(3): 537–545. doi:10.1111/iwj.12642.

Krittiyawong S, Ngarmukos C, Benjasurat-wong Y, Rawdaree P, Leelawatana R, Kosachunhanun N, et al. (2006). Thailand diabetes registry project: prevalence and risk factors associated with lower extremity amputation in Thai diabetiks. J Med Assoc Thai. 89(1): S43–S48.

López-de-Andrés A, Martínez-Huedo MA, Carrasco-Garrido P, Hernández-Bar-rera V, Gil-de-Miguel A, Jiménez-García R (2011). Trends in lower-extremity amputations in people with and without diabetes in Spain, 2001-2008. Diabetes care, 34(7): 1570–1576. https://doi.org/10.2337/dc11-0-077.

Magalhães P, Capingana DP, Silva AB, Capunge IR, Gonçalves MA (2011). Arterial stiffness in lower limb amputees. Clin med insights Circ respir pulm Med. 5: 49–56. https://doi.org-/10.4137/CCRPM.S7757.

Markowitz JS, Gutterman EM, Magee G, Margolis DJ (2006). Risk of amputa-tion in patients with diabetic foot ulcers: a claims-based study. Wound Repair Regen. 14(1): 11–17. https://doi.org/10.1111/j.1743-6109.2005.0-0083.x.

Moon KC, Kim SB, Han SK, Jeong SH, Dhong ES (2019). Risk factors for major amputation in hospitalized diabetik patients with forefoot ulcers. Diabetes Res Clin Pract, 158, 107905. doi:10.1016/j.diabres.2019.107905

Nanwani B, Shankar P, Kumar R, Shaukat F (2019). Risk factors of diabetic foot amputation in Pakistani Type II Dia-betes Individuals. Cureus, 11(6): e4-795. https://doi.org/10.7759/cureus.-4795.

O'Rourke MF, Nichols WW (2005). Aortic diameter, aortic stiffness, and wave reflection increase with age and isolated systolic hypertension. Hyperten-sion. 45(4): 652–658. https://doi.org/10.1161/01.HYP.0000153793.84859.b8.

Peek ME (2010). Gender differences in dia-betes-related lower extremity ampu-tations. Clin Orthop Relat Res, 469(7): 1951–1955. doi:10.1007/s119-99-010-1735-4.

Pemayun TGD, Naibaho RM, Novitasari D, Amin N, Minuljo TT (2015). Risk factors for lower extremity amputation in patients with diabetik foot ulcers: a hospital-based case–control study. Diabetic Foot & Ankle. 6(1): 29629. doi:10.3402/dfa.v6.29629.

Prompers L, Schaper N, Apelqvist J, Ed-monds M, Jude E, Mauricio, et al. (2008). Prediction of outcome in indi-viduals with diabetic foot ulcers: focus on the differences between indivi-duals with and without peripheral arterial disease. The EURODIALE Study. Diabetologia, 51(5): 747–755. https://doi.org/10.1007/s00125-008-0940-0.

Resnick HE, Carter EA, Sosenko JM, Henly SJ, Fabsitz RR, Ness FK, Welty TK, Lee ET, Howard BV, Strong Heart Study (2004). Incidence of lower-extremity amputation in American Indians: the Strong Heart Study. Dia-betes care, 27(8): 1885–1891. https://doi.org/10.2337/diacare.27.8.1885.

Rodrigues BT, Vangaveti VN, Malabu UH (2016). Prevalence and risk factors for diabetic lower limb amputation: A clinic-based case control study. Diabetes Res Clin Pract. 1–7. https://-doi.org/10.1155/2016/5941957.

Sayiner ZA, Can FI, Akarsu E (2019). Pati-ents’ clinical charecteristics and pre-dictors for diabetik foot amputation. Prim. Care Diabetes, 13(3): 247–251. doi:10.1016/j.pcd.2018.12.002

Shaw JE, Sicree RA, Zimmet PZ (2010). Global estimates of the prevalence of diabetes for 2010 and 2030. Diabetes Res. Clin. Pract. 87(1): 4–14. https://-doi.org/10.1016/j.diabres.2009.10.007.

Shin JY, Roh SG, Sharaf B, Lee NH (2017). Risk of major limb amputation in dia-betic foot ulcer and accompanying disease: A meta-analysis. Plast Re-constr Surg. 70(12): 1681–1688. https://doi.org/10.1016/j.bjps.2017.07.015

Vexels (2014). 5 Continent Wold Map Set. Retrieved from https://images.vexels.com/media/users/3/71348/raw/bd9e68d11a591a9a61eac5f8d07f0385-5-continent-world-map-set.jpg on November 2020

Welten GM, Schouten O, Chonchol M, Hoeks SE, Bax JJ, Van Domburg RT, Poldermans D (2009). Prognosis of patients with peripheral arterial dise-ase. J Thorac Cardiovasc Surg. 50(1): 109–121. PMID: 19179996.

WHO (2020). Diagnosis and Management of Type 2 Diabetes (Heart-D). Geneva. Switzerland. Retrieved from https://www.who.int/publications/i/item/who-ucn-ncd-20.1 on May 2020.

Yesil S, Akinci B, Yener S, Bayraktar F, Karabay O, Havitcioglu H, Yapar N, Atabey A, et al. (2009). Predictors of amputation in diabetics with foot ulcer: Single center experience in a large Turkish cohort. Hormones, 8(4): 286–295. https://doi.org/10.14310h-orm.2002.1245.

Young BA, Lin E, Von Korff M, Simon G, Ciechanowski P, Ludman EJ, Ever-son-Stewart S, Kinder L, et al. (2008). Diabetes complications severity index and risk of mortality, hospitalization, and healthcare utilization. Am J Manag Care, 14(1): 15–23. http://www.ncbi.nlm.nih.gov/pmc/articles/pmc3810070/.

Zubair M, Malik A, Ahmad J (2012). Inci-dence, risk factors for amputation among patients with diabetic foot ulcer in a North Indian tertiary care hospital. Foot (Edinb), 22(1): 24–30. https://doi.org/10.1016/j.foot.2011.09.003.

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2021-01-27

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