TY - JOUR
T1 - Risk factors for mortality in patients with diabetic foot infections
T2 - a prospective cohort study
AU - Lynar, Sarah A.
AU - Robinson, Claire H.
AU - Boutlis, Craig S.
AU - Commons, Robert J.
PY - 2019/7/1
Y1 - 2019/7/1
N2 - Background: An increasing prevalence of diabetes mellitus has led to a high risk of diabetic foot infections (DFI) and associated morbidity. However, little is known about the relationship between DFI and mortality. Aim: To investigate the risk of mortality and associated factors in patients with DFI in an Australian context. Methods: A prospective cohort study of inpatients with DFI between May 2012 and October 2016 was done at Royal Darwin Hospital, a tertiary referral hospital for the Top End of the Northern Territory. Primary outcome was 1-year mortality with Cox regression analysis undertaken to assess risk factors for mortality. Results: Four hundred and thirteen consecutive adult diabetic patients with 737 admissions were referred to the High-Risk Foot Service for DFI. Cumulative risk of mortality at 1 year was 8.9% (95% confidence interval (CI) 6.4–12.2). On univariable analysis, mortality was associated with older age (hazard ratio (HR) per year increase 1.08, 95% CI 1.06–1.11, P = 0.001), haemodialysis (HR 3.64, 1.74–7.62, P < 0.001), isolation of Pseudomonas aeruginosa (HR 2.32, 1.05–5.12, P = 0.04) and ischaemic heart disease (HR 2.05, 1.04–4.07, P = 0.04), while indigenous status (HR 0.48, 0.25–0.95, P = 0.04) and HbA1c > 7% (HR 0.45, 0.20–0.99, P < 0.05) were protective. After adjusting for confounders, independent risk factors for mortality were haemodialysis (adjusted HR 5.76, 95% CI 2.28–14.59, P < 0.001) and older age (adjusted HR 1.09, 1.06–1.13, P < 0.001). Patients on haemodialysis had a cumulative risk of mortality of 24.5% (95% CI 14.0–40.8) at 1 year. Conclusion: There is a high risk of mortality associated with DFI, substantially increased in patients undergoing haemodialysis, highlighting the importance of early and dedicated interventions targeted at this high-risk group.
AB - Background: An increasing prevalence of diabetes mellitus has led to a high risk of diabetic foot infections (DFI) and associated morbidity. However, little is known about the relationship between DFI and mortality. Aim: To investigate the risk of mortality and associated factors in patients with DFI in an Australian context. Methods: A prospective cohort study of inpatients with DFI between May 2012 and October 2016 was done at Royal Darwin Hospital, a tertiary referral hospital for the Top End of the Northern Territory. Primary outcome was 1-year mortality with Cox regression analysis undertaken to assess risk factors for mortality. Results: Four hundred and thirteen consecutive adult diabetic patients with 737 admissions were referred to the High-Risk Foot Service for DFI. Cumulative risk of mortality at 1 year was 8.9% (95% confidence interval (CI) 6.4–12.2). On univariable analysis, mortality was associated with older age (hazard ratio (HR) per year increase 1.08, 95% CI 1.06–1.11, P = 0.001), haemodialysis (HR 3.64, 1.74–7.62, P < 0.001), isolation of Pseudomonas aeruginosa (HR 2.32, 1.05–5.12, P = 0.04) and ischaemic heart disease (HR 2.05, 1.04–4.07, P = 0.04), while indigenous status (HR 0.48, 0.25–0.95, P = 0.04) and HbA1c > 7% (HR 0.45, 0.20–0.99, P < 0.05) were protective. After adjusting for confounders, independent risk factors for mortality were haemodialysis (adjusted HR 5.76, 95% CI 2.28–14.59, P < 0.001) and older age (adjusted HR 1.09, 1.06–1.13, P < 0.001). Patients on haemodialysis had a cumulative risk of mortality of 24.5% (95% CI 14.0–40.8) at 1 year. Conclusion: There is a high risk of mortality associated with DFI, substantially increased in patients undergoing haemodialysis, highlighting the importance of early and dedicated interventions targeted at this high-risk group.
KW - diabetes mellitus
KW - diabetic foot
KW - haemodialysis
KW - infection
KW - mortality
UR - http://www.scopus.com/inward/record.url?scp=85068888829&partnerID=8YFLogxK
U2 - 10.1111/imj.14184
DO - 10.1111/imj.14184
M3 - Article
C2 - 30515957
AN - SCOPUS:85068888829
VL - 49
SP - 867
EP - 873
JO - Internal Medicine Journal
JF - Internal Medicine Journal
SN - 1444-0903
IS - 7
ER -