Mortality in patients with diabetic foot ulcer

A retrospective study of 513 cases from a single Centre in the Northern Territory of Australia

Kanakamani Jeyaraman, Thomas Berhane, Mark Hamilton, Abhilash P. Chandra, Henrik Falhammar

Research output: Contribution to journalArticleResearchpeer-review

10 Downloads (Pure)

Abstract

Background: Diabetic foot ulcers (DFU) are a common problem in longstanding diabetes. However, mortality outcomes in Australian patients with DFU are still unclear.

Methods: All patients with DFU presenting for the first time to the Multi-Disciplinary Foot Clinic (MDFC) at Royal Darwin Hospital, Northern Territory Australia, between January 2003 and June 2015 were included in this study. These patients were followed until 2017, or death. Individual patient data was extracted from hospital and primary care information systems. Kaplan-Meier survival curves were developed. The association between various risk factors and mortality was analysed using Cox regression.

Results: In total 666 subjects were screened, and 513 were included in the final analysis. Of these subjects, 247 were Indigenous and 266 were non-Indigenous. The median follow-up period was 5.8 years (IQR, 3.1-9.8). The mean age at inclusion was 59.9 ± 12.3 years and 62.8% were males. The majority (93.6%) had type 2 diabetes and the median diabetes duration was 7 years (IQR, 3-12). There were 199 deaths, with a 5-year-mortality rate of 24.6%, and a 10-year-mortality rate of 45.4%. The mean age at death was 64.6 ± 11.8 years. In a multivariate analysis, the following variables were associated with mortality (adjusted HR, 95% CI): age 1.04 (1.02-1.05, P < 0.001); chronic kidney disease 1.22 (1.11-1.33, P < 0.001), and plasma albumin 0.96 (0.94-0.99, P < 0.05). The most common causes of death were chronic kidney disease (24.6%), cardiovascular events (19.6%), sepsis (15.6%), respiratory failure (10.0%), malignancy (9.5%) and multi-organ failure (5.0%).

Conclusion: Patients with DFU have high mortality. Age, chronic kidney disease, and low albumin levels increase the risk of mortality. Strategies should focus on ulcer prevention and aggressive risk factor reduction.

Original languageEnglish
Article number1
Pages (from-to)1-7
Number of pages7
JournalBMC Endocrine Disorders
Volume19
Issue number1
DOIs
Publication statusPublished - 3 Jan 2019

Fingerprint

Northern Territory
Diabetic Foot
Retrospective Studies
Mortality
Chronic Renal Insufficiency
Kaplan-Meier Estimate
Risk Reduction Behavior
Information Systems
Serum Albumin
Respiratory Insufficiency
Type 2 Diabetes Mellitus
Ulcer
Foot
Cause of Death
Albumins
Primary Health Care
Sepsis
Multivariate Analysis

Cite this

Jeyaraman, Kanakamani ; Berhane, Thomas ; Hamilton, Mark ; Chandra, Abhilash P. ; Falhammar, Henrik. / Mortality in patients with diabetic foot ulcer : A retrospective study of 513 cases from a single Centre in the Northern Territory of Australia. In: BMC Endocrine Disorders. 2019 ; Vol. 19, No. 1. pp. 1-7.
@article{fa50ded19e964d57875a7037b5ffed24,
title = "Mortality in patients with diabetic foot ulcer: A retrospective study of 513 cases from a single Centre in the Northern Territory of Australia",
abstract = "Background: Diabetic foot ulcers (DFU) are a common problem in longstanding diabetes. However, mortality outcomes in Australian patients with DFU are still unclear. Methods: All patients with DFU presenting for the first time to the Multi-Disciplinary Foot Clinic (MDFC) at Royal Darwin Hospital, Northern Territory Australia, between January 2003 and June 2015 were included in this study. These patients were followed until 2017, or death. Individual patient data was extracted from hospital and primary care information systems. Kaplan-Meier survival curves were developed. The association between various risk factors and mortality was analysed using Cox regression. Results: In total 666 subjects were screened, and 513 were included in the final analysis. Of these subjects, 247 were Indigenous and 266 were non-Indigenous. The median follow-up period was 5.8 years (IQR, 3.1-9.8). The mean age at inclusion was 59.9 ± 12.3 years and 62.8{\%} were males. The majority (93.6{\%}) had type 2 diabetes and the median diabetes duration was 7 years (IQR, 3-12). There were 199 deaths, with a 5-year-mortality rate of 24.6{\%}, and a 10-year-mortality rate of 45.4{\%}. The mean age at death was 64.6 ± 11.8 years. In a multivariate analysis, the following variables were associated with mortality (adjusted HR, 95{\%} CI): age 1.04 (1.02-1.05, P < 0.001); chronic kidney disease 1.22 (1.11-1.33, P < 0.001), and plasma albumin 0.96 (0.94-0.99, P < 0.05). The most common causes of death were chronic kidney disease (24.6{\%}), cardiovascular events (19.6{\%}), sepsis (15.6{\%}), respiratory failure (10.0{\%}), malignancy (9.5{\%}) and multi-organ failure (5.0{\%}). Conclusion: Patients with DFU have high mortality. Age, chronic kidney disease, and low albumin levels increase the risk of mortality. Strategies should focus on ulcer prevention and aggressive risk factor reduction.",
keywords = "Diabetes complications, Diabetes mellitus, Diabetic foot ulcer",
author = "Kanakamani Jeyaraman and Thomas Berhane and Mark Hamilton and Chandra, {Abhilash P.} and Henrik Falhammar",
year = "2019",
month = "1",
day = "3",
doi = "10.1186/s12902-018-0327-2",
language = "English",
volume = "19",
pages = "1--7",
journal = "BMC Endocrine Disorders",
issn = "1472-6823",
publisher = "BioMed Central",
number = "1",

}

Mortality in patients with diabetic foot ulcer : A retrospective study of 513 cases from a single Centre in the Northern Territory of Australia. / Jeyaraman, Kanakamani; Berhane, Thomas; Hamilton, Mark; Chandra, Abhilash P.; Falhammar, Henrik.

In: BMC Endocrine Disorders, Vol. 19, No. 1, 1, 03.01.2019, p. 1-7.

Research output: Contribution to journalArticleResearchpeer-review

TY - JOUR

T1 - Mortality in patients with diabetic foot ulcer

T2 - A retrospective study of 513 cases from a single Centre in the Northern Territory of Australia

AU - Jeyaraman, Kanakamani

AU - Berhane, Thomas

AU - Hamilton, Mark

AU - Chandra, Abhilash P.

AU - Falhammar, Henrik

PY - 2019/1/3

Y1 - 2019/1/3

N2 - Background: Diabetic foot ulcers (DFU) are a common problem in longstanding diabetes. However, mortality outcomes in Australian patients with DFU are still unclear. Methods: All patients with DFU presenting for the first time to the Multi-Disciplinary Foot Clinic (MDFC) at Royal Darwin Hospital, Northern Territory Australia, between January 2003 and June 2015 were included in this study. These patients were followed until 2017, or death. Individual patient data was extracted from hospital and primary care information systems. Kaplan-Meier survival curves were developed. The association between various risk factors and mortality was analysed using Cox regression. Results: In total 666 subjects were screened, and 513 were included in the final analysis. Of these subjects, 247 were Indigenous and 266 were non-Indigenous. The median follow-up period was 5.8 years (IQR, 3.1-9.8). The mean age at inclusion was 59.9 ± 12.3 years and 62.8% were males. The majority (93.6%) had type 2 diabetes and the median diabetes duration was 7 years (IQR, 3-12). There were 199 deaths, with a 5-year-mortality rate of 24.6%, and a 10-year-mortality rate of 45.4%. The mean age at death was 64.6 ± 11.8 years. In a multivariate analysis, the following variables were associated with mortality (adjusted HR, 95% CI): age 1.04 (1.02-1.05, P < 0.001); chronic kidney disease 1.22 (1.11-1.33, P < 0.001), and plasma albumin 0.96 (0.94-0.99, P < 0.05). The most common causes of death were chronic kidney disease (24.6%), cardiovascular events (19.6%), sepsis (15.6%), respiratory failure (10.0%), malignancy (9.5%) and multi-organ failure (5.0%). Conclusion: Patients with DFU have high mortality. Age, chronic kidney disease, and low albumin levels increase the risk of mortality. Strategies should focus on ulcer prevention and aggressive risk factor reduction.

AB - Background: Diabetic foot ulcers (DFU) are a common problem in longstanding diabetes. However, mortality outcomes in Australian patients with DFU are still unclear. Methods: All patients with DFU presenting for the first time to the Multi-Disciplinary Foot Clinic (MDFC) at Royal Darwin Hospital, Northern Territory Australia, between January 2003 and June 2015 were included in this study. These patients were followed until 2017, or death. Individual patient data was extracted from hospital and primary care information systems. Kaplan-Meier survival curves were developed. The association between various risk factors and mortality was analysed using Cox regression. Results: In total 666 subjects were screened, and 513 were included in the final analysis. Of these subjects, 247 were Indigenous and 266 were non-Indigenous. The median follow-up period was 5.8 years (IQR, 3.1-9.8). The mean age at inclusion was 59.9 ± 12.3 years and 62.8% were males. The majority (93.6%) had type 2 diabetes and the median diabetes duration was 7 years (IQR, 3-12). There were 199 deaths, with a 5-year-mortality rate of 24.6%, and a 10-year-mortality rate of 45.4%. The mean age at death was 64.6 ± 11.8 years. In a multivariate analysis, the following variables were associated with mortality (adjusted HR, 95% CI): age 1.04 (1.02-1.05, P < 0.001); chronic kidney disease 1.22 (1.11-1.33, P < 0.001), and plasma albumin 0.96 (0.94-0.99, P < 0.05). The most common causes of death were chronic kidney disease (24.6%), cardiovascular events (19.6%), sepsis (15.6%), respiratory failure (10.0%), malignancy (9.5%) and multi-organ failure (5.0%). Conclusion: Patients with DFU have high mortality. Age, chronic kidney disease, and low albumin levels increase the risk of mortality. Strategies should focus on ulcer prevention and aggressive risk factor reduction.

KW - Diabetes complications

KW - Diabetes mellitus

KW - Diabetic foot ulcer

UR - http://www.scopus.com/inward/record.url?scp=85059493962&partnerID=8YFLogxK

U2 - 10.1186/s12902-018-0327-2

DO - 10.1186/s12902-018-0327-2

M3 - Article

VL - 19

SP - 1

EP - 7

JO - BMC Endocrine Disorders

JF - BMC Endocrine Disorders

SN - 1472-6823

IS - 1

M1 - 1

ER -