Risk factors affecting the development of adverse outcomes in patients with diabetic foot infection

Abstract

Introduction: Diabetic foot infection (DFI) can result in lower extremity amputation and death in patients with diabetes and is an important cause of morbidity and mortality. The purpose of this study was to identify predictive factors for adverse outcomes consisting of major lower extremity amputation and mortality in patients with DFI.

Methodology: One hundred and two patients diagnosed with DFI and followed up in a tertiary hospital between November 2022 and April 2023 were included in this prospective study. Demographic and diabetic foot characteristics at the time of presentation, degrees of DFI, and clinical and laboratory findings of all patients were recorded. Major amputation and/or mortality were regarded as adverse outcomes. The patients were followed up throughout hospitalization until discharge or mortality. Risk factors for adverse outcomes were identified using univariate and multivariate logistic regression analyses.

Results: The median age of the patients was 60.0 years, and the majority (72.5%) were men. Adverse outcomes developed in 11 patients during follow-up. The factors linked to adverse outcomes included fever; wound necrosis; isolation of Enterobacteriaceae species in wound culture; perfusion, extent, depth, infection, and sensation (PEDIS) grade 4; and blood urea nitrogen (BUN) elevation. Following multivariate logistic regression analysis, only BUN > 31 mg/dL and presence of necrosis emerged as significant independent predictive factors for adverse outcomes.

Conclusions: The findings show that the above factors may be useful in predicting adverse outcomes in patients with DFI. Early detection of these factors may be useful in preventing morbidity and mortality in these patients.