RESUMO
Introducción: Se define como pie diabético toda infección, úlcera o destrucción tisular del pie asociada a neuropatía y/o enfermedad vascular periférica de miembros inferiores en personas con diabetes. Objetivo: Determinar la tasa de mortalidad en personas con pie diabético en La Habana durante el período 2010-2015, así como las causas y las variables sociodemográficas de los fallecidos. Método: Estudio observacional, descriptivo y retrospectivo. Se revisó el registro de fallecidos por diabetes mellitus en La Habana como causa básica de muerte de los años comprendidos del 2010 al 2015, Se analizaron las variables edad, sexo, causa básica de muerte, amputaciones y municipio de procedencia. Los resultados se expresaron en frecuencias absolutas, relativas y tasas por 100 000 habitantes. Resultados: La tasa de mortalidad en personas con pie diabético fue de 3,07/105 habitantes. El año de mayor mortalidad fue el 2010 (10,41 por ciento) y el de menor fue el 2011 (7,34 por ciento). Predominaron las mujeres (56 por ciento) y los mayores de 70 años (66,5 por ciento). En el 48,5 por ciento de los casos se reportaron amputaciones. Las causas directas de muerte más frecuente fueron: la sepsis (34,5 por ciento), el tromboembolismo pulmonar (32,2 por ciento) y la bronconeumonía (21,1 por ciento). Los municipios con menores tasas de fallecidos fueron La Habana Vieja y Arroyo Naranjo. Conclusiones: La tasa de mortalidad en personas con pie diabético en el período 2010-2015 tuvieron una tendencia a la disminución. Las cifras más elevadas se observaron en la edad y en el sexo femenino. Las infecciones, el tromboembolismo pulmonar y la bronconeumonía fueron las causas de muerte directa más importantes(AU)
Introduction: Mortality due to diabetes mellitus may rise due to an increase in its prevalence and the risk of chronic complications. Objective: To determine the mortality rate in people with diabetic foot in Havana during the 2010-2015 period, as well as the causes and sociodemographic variables of the deceased. Methods: Observational, descriptive and retrospective study. The registry of deaths from diabetes mellitus as the basic cause of death from 2010 to 2015 was reviewed. The variables age, sex, basic cause of death, amputations and municipality of origin were analyzed. The results were expressed in absolute and relative frequencies, as well as in rates per hundred thousand inhabitants. Results: The mortality rate in people with diabetic foot was 3.07/105 inhabitants. The year with the highest mortality was 2010 (10.41 percent) and the year with the lowest value was 2011 (7.34 percent). Women (56 percent) and those aged over seventy years (66.5 percent) predominated. In 48.5 percent of the cases accounted for amputations. The most frequent direct causes of death were sepsis (34.5 percent), pulmonary thromboembolism (32.2 percent) and bronchopneumonia (21.1 percent). The municipalities with the lowest death rates were La Habana Vieja and Arroyo Naranjo. Conclusions: Mortality rates in people with diabetic foot in the 2010-2015 period tended to decrease. The highest figures were observed in geriatric ages and among women. Infections, pulmonary embolism and bronchopneumonia were the most important direct causes of death(AU)
Assuntos
Humanos , Feminino , Idoso , Pé Diabético/mortalidade , Diabetes Mellitus/etiologia , Amputação Cirúrgica/mortalidade , Broncopneumonia/mortalidade , Epidemiologia Descritiva , Estudos Retrospectivos , Causas de Morte , Estudos Observacionais como AssuntoRESUMO
OBJECTIVES: Identify in patients with type 2 diabetes what changes in the feet would be associated with demographic, clinical, biochemical and treatment characteristics and which would increase the risk of mortality. METHODS: Retrospective longitudinal study evaluating the alterations in feet of outpatients attended at a nursing visit. Data from the clinical history and foot exam were collected from 918 medical records of a convenience sample. RESULTS: At 10 years, the cumulative mortality attributable to peripheral polyneuropathy was 44.7%, to peripheral artery disease was 71.7%, to both conditions were 62.4%, and to amputation was 67.6%. After multivariate analysis, duration of nursing follow-up remained as the only protective factor against death (p < 0.001). CONCLUSIONS: The risk of death in these patients decreased when they had consultations with a nurse educator. Ischemic feet, amputation, and coronary artery disease remained independent risk factors.
Assuntos
Diabetes Mellitus Tipo 2/mortalidade , Pé Diabético/mortalidade , Amputação Cirúrgica/mortalidade , Doenças Cardiovasculares/mortalidade , Causas de Morte , Diabetes Mellitus Tipo 2/complicações , Diabetes Mellitus Tipo 2/terapia , Pé Diabético/enfermagem , Pé Diabético/prevenção & controle , Neuropatias Diabéticas/mortalidade , Feminino , Humanos , Estimativa de Kaplan-Meier , Estudos Longitudinais , Masculino , Pessoa de Meia-Idade , Análise Multivariada , Pacientes Ambulatoriais , Educação de Pacientes como Assunto , Doença Arterial Periférica/mortalidade , Estudos Retrospectivos , Fatores de Risco , Taxa de Sobrevida , Fatores de Tempo , CicatrizaçãoRESUMO
A lesão no pé de pacientes com diabetes é um importante problema de saúde pública que frequentemente está associado a amputações em membros inferiores e mortalidade nessa população. Objetivos: Investigar os fatores de risco associados a mortalidade em pacientes com pé diabético infectado submetidos a amputação maior. Métodos: Estudo observacional, retrospectivo e caso-controle. Amostra composta por 78 pacientes com pé diabético e úlcera infectada submetidos a amputação maior em um serviço de cirurgia vascular em um hospital universitário no período de 5 anos. Resultados: A média de idade da amostra estudada foi de 63,8 ± 10,5 anos, com 54 (69,2%) pacientes do sexo masculino, com creatinina sérica média de 2,49 ± 2,4 mg/dL e hemoglobina sérica média de 7,36 ± 1,7 g/dL. Houve 47,4% de reinternação. Foi realizada amputação transtibial em 59,0% e transfemoral em 39,7% da amostra estudada. Nesta amostra, 87,2% dos pacientes apresentaram cultura positiva, predominantemente monomicrobiana (67,9%), e 30,8% presentaram infecção hospitalar da úlcera. Os gêneros de bactérias mais frequentes foram Acinetobacter spp. (24,4%), Morganella spp. (24,4%) e Proteus spp. (23,1%). Nenhum gênero bacteriano foi identificado como fator de risco para óbito. O nível de creatinina ≥ 1,3 mg/dL (OR 17,8; IC 2,1-150) e a amputação transfemoral (OR 4,5; C: 1,3-15,7) foram fatores de risco para o óbito. Conclusões: Os níveis séricos de creatinina ≥ 1,3 mg/dL e amputação transfemoral foram fatores de risco para óbito
Foot ulcers in patients with diabetes are a major public health problem and are often associated with lower limbs amputation and mortality in this population. Objectives: To investigate the risk factors associated with mortality in patients with infected diabetic foot ulcers and major lower limb amputations. Methods: This was an observational, retrospective, case-control study with a sample of 78 patients with infected diabetic foot ulcers who had major lower limb amputations at a Vascular Surgery Service at a university hospital. Results: The mean age of the study sample was 63.8 ± 10.5 years, 54 (69.2%) were male, mean serum creatinine was 2.49 ± 2.4 mg/dL and mean serum hemoglobin was 7.36 ± 1.7 g/dL.There was a 47.4% rate of readmissions to the same hospital.Transtibial amputation was performed in 59.0%; and transfemoral amputation in 39.7% of the sample. In this sample, 87.2% had a positive culture, predominantly (68.0%) monomicrobial and nosocomial infection of ulcers was observed in 30.8%. The most common bacterial genera were Acinetobacter spp. (24.4%), Morganella spp. (24.4%) and Proteus spp. (23.1%). No bacterial genus was identified as a predictor of death. Creatinine level ≥ 1.3 mg/dL (OR 17.8; IC 2.1-150) and transfemoral amputation (OR 4.5; IC: 1.3-15.7) were associated with death. Conclusions: Serum creatinine levels ≥ 1.3 mg/dL and transfemoral amputation were risk factors for death
Assuntos
Humanos , Masculino , Feminino , Pessoa de Meia-Idade , Fatores de Risco , Pé Diabético/mortalidade , Amputação Cirúrgica , Infecção dos Ferimentos , Comorbidade , Infecção Hospitalar/complicações , Úlcera do Pé/complicações , Extremidade Inferior , Diabetes Mellitus/mortalidade , Nefropatias Diabéticas/mortalidade , Estudo Observacional , Infecções , Antibacterianos/uso terapêuticoRESUMO
BACKGROUND: Amputations of lower limbs can be conducted as one-stage amputation (OSA) or staged amputation (SA) procedures. The objective of this study was to analyze technical success and mortality rates of both techniques, as well as factors that might influence outcomes in patients with critical limb ischemia (CLI). METHODS: A retrospective study of 185 consecutive patients with CLI who underwent amputations in the period 2004-2011. Primary end points were rates of technical success (healing without dehiscence or reintervention) and mortality. The influence on outcomes of demographic data, clinical status, and comorbidities was also analyzed by logistic regression. RESULTS: A total of 101 SA (91 patients) and 106 OSA (94 patients) were analyzed. SA had proportionally higher success rate (SA 77.2% vs. OSA 66.0%, P = 0.0253), lower perioperative mortality rate (SA, 10.9% vs. OSA, 20.7%, P = 0.0247), and lower 30-day mortality rate (SA, 12.2% vs. OSA, 23.8%, P = 0.0220) in spite of more cases with Rutherford classes 5 and 6 (SA, 87.1% vs. OSA, 72.6%, P = 0.0047), diabetes (71.2% vs. 55.6%, P = 0.0076), and infection (44.5% vs. 28.3%, P = 0.0061). Logistic regression demonstrated that in SA, success was more frequent in patients with diabetes who did not use insulin (P = 0.0072), in those with transfemoral amputations (P = 0.0392), with no coronary artery disease (P = 0.0053), and in foot infection (P = 0.0446), while for OSA success was more frequent in nondiabetic patients (P = 0.0077), limbs without infection (P = 0.0298), amputations at foot level (P = 0.0155), or transfemoral amputations (P = 0.0030). CONCLUSIONS: SA had a higher rate of technical success and lower mortality rates than OSA, even with greater number of patients with diabetes and more severe cases of ischemia and infection. However, prospective studies comparing both techniques are needed for further evidence.
Assuntos
Amputação Cirúrgica/métodos , Pé Diabético/cirurgia , Isquemia/cirurgia , Extremidade Inferior/irrigação sanguínea , Doença Arterial Periférica/cirurgia , Infecção dos Ferimentos/cirurgia , Idoso , Amputação Cirúrgica/efeitos adversos , Amputação Cirúrgica/mortalidade , Comorbidade , Estado Terminal , Pé Diabético/diagnóstico , Pé Diabético/mortalidade , Pé Diabético/fisiopatologia , Feminino , Humanos , Isquemia/diagnóstico , Isquemia/mortalidade , Isquemia/fisiopatologia , Estimativa de Kaplan-Meier , Modelos Logísticos , Masculino , Pessoa de Meia-Idade , Doença Arterial Periférica/diagnóstico , Doença Arterial Periférica/mortalidade , Doença Arterial Periférica/fisiopatologia , Modelos de Riscos Proporcionais , Estudos Retrospectivos , Fatores de Risco , Fatores de Tempo , Resultado do Tratamento , Cicatrização , Infecção dos Ferimentos/diagnóstico , Infecção dos Ferimentos/mortalidade , Infecção dos Ferimentos/fisiopatologiaRESUMO
Resumo OBJETIVO SIdentificar em pacientes com diabetes tipo 2 quais alterações nos pés estariam associadas às características demográficas, clínicas, bioquímicas e de tratamento e quais delas aumentariam o risco de mortalidade. MÉTODOS Estudo longitudinal retrospectivo que avaliou as alterações nos pés de pacientes externos atendidos em consulta de enfermagem. Os dados da história clínica e do exame dos pés foram coletados de 918 prontuários de uma amostra por conveniência. RESULTADOS Em 10 anos, a mortalidade cumulativa atribuída a polineuropatia sensitiva periférica foi 44,7%, pela doença vascular periférica 71,7%, pela associação das duas condições 62,4% e pela amputação 67,6%. Após análise multivariável, o tempo de acompanhamento com enfermeiros permaneceu como único fator de proteção para a mortalidade (p < 0,001). CONCLUSÃO O risco de morrer nesses pacientes diminuiu quando consultaram com enfermeiros educadores. Permaneceu como fator de risco independente pacientes com pé isquêmico, amputação e doença arterial coronariana.
Resumen OBJETIVOS Identificar en pacientes con diabetes tipo 2 que alteraciones en los pies estarían asociadas a las características demográficas, clínicas, bioquímicas y de tratamiento y cuáles de ellas aumentarían el riesgo de mortalidad. MÉTODOS Estudio longitudinal retrospectivo que evaluó los cambios en los pies de pacientes externos atendidos en consulta de enfermería. Los datos de la historia clínica y del examen de los pies fueron recolectados de 918 prontuarios, una muestra por conveniencia. RESULTADOS En 10 años, la mortalidad acumulativa atribuida a la polineuropatía sensitiva periférica fue 44.7%, por la enfermedad vascular periférica 71.7%, por la asociación de las dos condiciones 62.4% y por la amputación 67.6%. Después del análisis multivariable, el tiempo de acompañamiento con enfermeros permaneció como único factor de protección para la mortalidad (p < 0,001). CONCLUSIÓN El riesgo de morir en estos pacientes disminuyó cuando consultaron con enfermeros educadores. Se mantuvo como factor de riesgo independiente pacientes con pie isquémico, amputación y enfermedad arterial coronaria.
Abstract OBJECTIVES Identify in patients with type 2 diabetes what changes in the feet would be associated with demographic, clinical, biochemical and treatment characteristics and which would increase the risk of mortality. METHODS Retrospective longitudinal study evaluating the alterations in feet of outpatients attended at a nursing visit. Data from the clinical history and foot exam were collected from 918 medical records of a convenience sample. RESULTS At 10 years, the cumulative mortality attributable to peripheral polyneuropathy was 44.7%, to peripheral artery disease was 71.7%, to both conditions were 62.4%, and to amputation was 67.6%. After multivariate analysis, duration of nursing follow-up remained as the only protective factor against death (p < 0.001). CONCLUSIONS The risk of death in these patients decreased when they had consultations with a nurse educator. Ischemic feet, amputation, and coronary artery disease remained independent risk factors.
Assuntos
Humanos , Masculino , Feminino , Pé Diabético/mortalidade , Diabetes Mellitus Tipo 2/mortalidade , Pacientes Ambulatoriais , Fatores de Tempo , Cicatrização , Doenças Cardiovasculares/mortalidade , Educação de Pacientes como Assunto , Análise Multivariada , Taxa de Sobrevida , Estudos Retrospectivos , Fatores de Risco , Estudos Longitudinais , Causas de Morte , Pé Diabético/enfermagem , Pé Diabético/prevenção & controle , Diabetes Mellitus Tipo 2/complicações , Diabetes Mellitus Tipo 2/terapia , Neuropatias Diabéticas/mortalidade , Estimativa de Kaplan-Meier , Doença Arterial Periférica/mortalidade , Amputação Cirúrgica/mortalidade , Pessoa de Meia-IdadeRESUMO
PURPOSE OF REVIEW: This article reviewed very recent papers (2016) discussing or bringing clinical evidences of the possible common pathways leading to diabetic foot syndrome (DFS) and increased mortality rates. RECENT FINDINGS: Diabetic patients with diabetic foot syndrome have a mortality rate greater than twofold when compared with non-ulcerated diabetics. In addition, the 5-year mortality rate following amputation is estimated at 39-68%, a life expectancy comparable to aggressive types of cancer or advanced congestive heart failure. The majority of patients with diabetic foot ulcer also present insulin resistance, central obesity, dyslipidemia, and hypertension that characterize the metabolic syndrome that, in turn, is associated with an elevated risk of major cardiovascular events. Sensory neuropathy is the primary cause of more the 60% of diabetic foot ulcer. Diabetic peripheral neuropathy is a microvascular complication of diabetes mellitus and in type 2 diabetes, not only hyperglycemia but also other metabolic alterations and persistent inflammatory status due to adiposity play a major role in axon injury. Elevated triglycerides have been showed to be an independent risk factor for lower extremity amputation in diabetic patients. Also, toxic adiposity, oxidative stress, mitochondrial dysfunction, activation of the polyol pathway, accumulation of advanced glycation end products (AGEs), and elevation of inflammatory markers are also implicated in diabetic vascular disease and neuropathy. The hypotheses that the association between DFS and increased rates of mortality reflects the progression of micro- and macrovascular complications are reinforced by the additional association of DFU to renal failure and retinopathy.
Assuntos
Doenças Cardiovasculares/mortalidade , Pé Diabético/mortalidade , Amputação Cirúrgica , Angiopatias Diabéticas/complicações , Angiopatias Diabéticas/mortalidade , Pé Diabético/etiologia , Pé Diabético/cirurgia , Neuropatias Diabéticas/complicações , Neuropatias Diabéticas/mortalidade , Progressão da Doença , Humanos , Fatores de RiscoRESUMO
INTRODUCTION: Foot ulcer is also a clinical marker for limb amputation and for death in diabetic patients. The purpose of this study was to determine amputation and mortality rates and its associated factors in patients with diabetic foot ulcerations in a tertiary hospital in Brazil. METHODS: Retrospective medical records from 654 diabetic foot patients were reviewed. The risk factors were determined using the conditional logistic regression model analysis. RESULTS: The mean patient age was 63.1 years (SD 12.20). Peripheral arterial disease was present in 160 patients (24.5%). Major amputations were performed in 135 (21%). The in-hospital mortality rate was 12% and the mortality rate of the amputees was 22.2%. The lowest hemoglobin level, the median value was 9.50g/dL, (4.0-17.0). Anemia was detected in 89.6% of patients submitted to amputation and in 82,1% of those who died. Hemoglobin <11g/dL was the most significant risk factor for major amputation (odds ratio 5.57, p<0.0001). The presence of peripheral arterial disease and old age were also a risk for major amputation (odds ratio 1.84, p=0.007 and 1.02, p=0.028, respectively). Factors associated with increased risk for death were hemoglobin <11g/dL (odds ratio 4.04, p<0.001), major amputation (1.79, p=0.03) and old age (1.05, p<0,001). CONCLUSIONS: Diabetic foot ulcer is associated with high amputation and mortality rates. Old age, peripheral arterial disease and low hemoglobin level are risk factor for major amputation. Old age, major amputation and low hemoglobin level are risk factors for death.
Assuntos
Envelhecimento , Amputação Cirúrgica , Anemia/complicações , Pé Diabético/cirurgia , Doença Arterial Periférica/complicações , Adulto , Idoso , Pé Diabético/sangue , Pé Diabético/mortalidade , Feminino , Hemoglobinas/análise , Humanos , Modelos Logísticos , Masculino , Pessoa de Meia-Idade , Estudos RetrospectivosRESUMO
AIMS: The presence of diabetic foot ulcers is strongly associated with an increased risk of death. In this study, we investigate whether the effects of diabetes-associated complications can explain the apparent relationship between diabetic foot ulcers and death. METHODS: We analysed data from 414 523 people with diabetes enrolled in practices associated with The Health Improvement Network in the United Kingdom. Our methods were designed to control for potential confounders in order to isolate the relationship between diabetic foot ulcers and death. Using proportional hazards models and the area under the receiver operator curve, we evaluated the effects of diabetic foot ulcers and the covariates on death. RESULTS: Among the patients, 20 737 developed diabetic foot ulcers; 5.0% of people with new ulcers died within 12 months of their first foot ulcer visit and 42.2% of people with foot ulcers died within 5 years. After controlling for major known complications of diabetes that might influence mortality, the correlation between diabetic foot ulcers and death remained strong with a fully adjusted hazard ratio of 2.48 (95% confidence interval: 2.43, 2.54). Geographic variance existed but was not spatially associated. CONCLUSIONS: Diabetic foot ulcers are linked to an increased risk of death. This cannot be explained by other common risk factors. These results suggest that either there are major unknown risk factors associated with both diabetic foot ulcers and death, or that diabetic foot ulceration itself is a serious threat, which seems unlikely. A diabetic foot ulcer should be seen as a major warning sign for mortality, necessitating closer medical follow-up.
Assuntos
Pé Diabético/mortalidade , Úlcera do Pé/mortalidade , Idoso , Idoso de 80 Anos ou mais , Causas de Morte , Estudos de Coortes , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Fatores de Risco , Análise de Sobrevida , Reino Unido/epidemiologiaRESUMO
OBJECTIVE: The goal of the study was to determine whether complications of diabetes well-known to be associated with death such as cardiovascular disease and renal failure fully explain the higher rate of death in those who have undergone a lower-extremity amputation (LEA). RESEARCH DESIGN AND METHODS: This was a longitudinal cohort study of patients cared for in the Health Improvement Network. Our primary exposure was LEA and outcome was all-cause death. Our "risk factor variables" included a history of cardiovascular disease (a history of myocardial infarctions, cerebrovascular accident, and peripheral vascular disease/arterial insufficiency), Charlson index, and a history of chronic kidney disease. We estimated the effect of LEA on death using Cox proportional hazards models. RESULTS: The hazard ratio (HR) for death after an LEA was 3.02 (95% CI 2.90, 3.14). The fully adjusted (all risk factor variables) LEA HR was diminished only by â¼22% to 2.37 (2.27, 2.48). Furthermore, LEA had an area under the receiver operating curve (AUC) of 0.51, which is poorly predictive, and the fully adjusted model had an AUC of 0.77, which is better but not strongly predictive. Sensitivity analysis revealed that it is unlikely that there exists an unmeasured confounder that can fully explain the association of LEA with death. CONCLUSIONS: Individuals with diabetes and an LEA are more likely to die at any given point in time than those who have diabetes but no LEA. While some of this variation can be explained by known complications of diabetes, there remains a large amount of unexplained variation.
Assuntos
Amputação Cirúrgica/mortalidade , Angiopatias Diabéticas/mortalidade , Idoso , Pé Diabético/mortalidade , Pé Diabético/cirurgia , Nefropatias Diabéticas/mortalidade , Métodos Epidemiológicos , Feminino , Humanos , Masculino , Reino Unido/epidemiologiaRESUMO
The aim of this article was to validate the checklist contribution of 10 factors relevant to healing in order to score the severity of diabetic foot ulcers. A total of 235 patients from January 2007 to January 2009 were scored according to the Saint Elian Wound Score System from mild to severe (1 to 3) in the following categories: location, topographic aspects, and number of affected zones, ischemia, infection, edema, neuropathy, depth, area, and wound healing phase. The score sum was graded as I (score Assuntos
Lista de Checagem/métodos
, Pé Diabético/diagnóstico
, Índice de Gravidade de Doença
, Cicatrização
, Amputação Cirúrgica
, Índice Tornozelo-Braço
, Intervalos de Confiança
, Diabetes Mellitus Tipo 2
, Pé Diabético/classificação
, Pé Diabético/mortalidade
, Pé Diabético/cirurgia
, Indicadores Básicos de Saúde
, Humanos
, Estimativa de Kaplan-Meier
, Modelos Logísticos
, Pessoa de Meia-Idade
, Análise Multivariada
, Razão de Chances
, Prognóstico
, Modelos de Riscos Proporcionais
, Fatores de Tempo
, Resultado do Tratamento
RESUMO
OBJECTIVES: To determine the age-standardized rate of lower limb amputations among Type 2 diabetics admitted to the Port of Spain General Hospital (POSGH), San Fernando General Hospital (SFGH) and Sangre Grande County Hospital (SGCH) for the period 2000-2004. To determine in-hospital mortality following amputation, for the same period. To determine the risk factors that contributed to diabetic foot complications. DESIGN AND METHODS: All patients who had a lower limb amputation at the three major public health institutions in Trinidad during the study period were enrolled. In addition patients attending the surgical out-patient clinic and currently admitted to the ward with a diabetic septic foot was selected for the administration of a questionnaire to determine the major contributing factors. Data on the type of amputation, age, sex, ethnicity, from which an age-standardized mortality rate, was determined for the age group 30-60. RESULTS: Of 822 patient files examined, 515 (80%) of these major amputations were performed on Type 2 diabetics, of which 352 (68%) were AKA and 163 (32%) were BKA. The AKA:BKA ratio for the period 2000-2004 was 2.2:1. There was a significant difference between the mean ages at which females had a major amputation to males (p=0.001). The overall ratio of Africans to South East Asians was 1.5:1 amongst the Type 2 diabetic amputees. For major amputations the average length of stay was found to be 22.5 (0-192) days. The age-standardized rate for the age group 30-60 was 13.85 per 100,000 for 2004. Of 66 deaths, 31 (47%) were septicemia cases and 14 (21%) cardio-respiratory failure cases. Finally, of 97 persons interviewed, the major causative agent for diabetic foot complications and amputations was foot trauma (51%). CONCLUSION: Type 2 diabetic amputation status of Trinidad would seem to have improved as shown by this study. However, steps must be taken to improve patient awareness about prevention and care of the diabetic foot. Doctors must also seek to increase their vigilance when screening diabetic patient in the primary care setting in order to prevent the late detection and treatment of the septic lower limb.
Assuntos
Amputação Cirúrgica , Diabetes Mellitus Tipo 2/cirurgia , Pé Diabético/cirurgia , Adulto , Distribuição por Idade , Fatores Etários , Idoso , Idoso de 80 Anos ou mais , Amputação Cirúrgica/efeitos adversos , Amputação Cirúrgica/mortalidade , Atitude do Pessoal de Saúde , Diabetes Mellitus Tipo 2/complicações , Diabetes Mellitus Tipo 2/etnologia , Diabetes Mellitus Tipo 2/mortalidade , Pé Diabético/etnologia , Pé Diabético/etiologia , Pé Diabético/mortalidade , Feminino , Conhecimentos, Atitudes e Prática em Saúde , Mortalidade Hospitalar , Humanos , Tempo de Internação , Masculino , Pessoa de Meia-Idade , Educação de Pacientes como Assunto , Estudos Retrospectivos , Inquéritos e Questionários , Fatores de Tempo , Resultado do Tratamento , Trinidad e Tobago/epidemiologiaRESUMO
Emergencies that involve the foot in diabetic patients are a very common cause of morbidity. Ischemia is of prime importance but, in addition, neuropathy (with hypoesthesia) and sepsis are factors. Infections may follow minor trauma, or may be secondary, either to a long-standing ulcer or to an area of gangrene. The major importance of chronic ulcers of the feet, is that they are a portal of entry for infection. All these considerations are described in the article, with special considerations to the shoes employed and the stay.
Assuntos
Humanos , Doenças Vasculares Periféricas/patologia , Doenças do Pé/patologia , Neuropatias Diabéticas/mortalidade , Neuropatias Diabéticas/patologia , Perfusão , Pé Diabético/fisiopatologia , Pé Diabético/mortalidadeRESUMO
Cohorte única de 121 pacientes portadores de pie diabético (PD) tratados entre 1998 y 2005. Se analiza la evolución, a través de incidencia de cicatrización, recidiva, amputación al año, a los tres años y letalidad. El origen del PDfue predominantemente neuropático en 52 pacientes (43 por ciento), predominantemente isquémico en 44 (36.4 por ciento) y mixto en 25 casos (20.6 por ciento). En 78 casos (64.5 por ciento) había infección asociada. Las lesiones mayores que Wagner 1 tuvieron cicatrización significativamente menor, p < 0.05. La media de antigüedad de la úlcera fue 10.8 semanas. La tasa de cicatrización, 31.4 por ciento y el tiempo medio de cicatrización, 6.2 semanas; la tasa de recidiva de la úlcera durante el primer año fue 52.1 por ciento. La media de tiempo para la recidiva de la úlcera fue 5.1 meses. La tasa de amputación al año de diagnosticada la úlcera fue 95.9 por ciento y 98.3 por ciento a los tres años. La tasa de reamputación de amputaciones menores fue 55.4 por ciento y de amputaciones mayores fue 24.4 por ciento, p < 0.05. La media entre el inicio del tratamiento y la amputación fue 11 semanas. La cirugía de rescate no modificó el desenlace de amputación (p =0.98). La letalidad fue 4.1 por ciento. Los grupos de riesgo de amputación fueron: diabéticos tipo 2 y lesiones Wagner 2 y superiores. Nuestro pobre desenlace del PD requiere implementar un plan de educación para reducir la aparición de úlcera y/ o infección local, disminuir la recidiva, mejorar la educación de los diabéticos respecto al cuidado de los pies y, replantear los niveles de amputaciones en el PD avanzado.
Background: Fifteen percent of diabetic patients will develop a foot ulcer during their lifetime. The predisposing conditions are neuropathy, ischemia and infections. Aim: To report the incidence of healing, relapse, amputation and mortality of diabetic foot in a period of eight years. Material and methods: A cohort of 134 patients hospitalized in a Surgical Service with the diagnosis of diabetic foot was studied; however in 13 patients, the clinical history was not available. Therefore the series included 81 males aged 68 + 11 years and 40 females aged 72 + 11 years. Results: Diabetic foot was predominantly neuropathic in 52 patients (43 percent), predominantly ischemic in 44 (36 percent) and mixed in 25 (21 percent). An associated infection was found in 78 patients (65 percent). The mean ulcer duration was 11 weeks. The rate of healing was 31 percent and the mean healing lapse was 6.2 weeks. The rate of relapse in the first year was 52 percent. The mean relapse time was 5.1 months. The amputation rate was 96 percent one year after diagnosis and 98 percent, three years after diagnosis. Minor and major amputation rates were 55 and 24 percent, respectively. The mean lapse between treatment onset and amputation was 11 weeks. Rescue surgical procedures did not modify the evolution of diabetic foot. Four percent of patients died. Conclusions: The overall results of diabetic foot treatment are poor. Therefore the efforts must be placed on prevention and education of patients to prevent the appearance of foot ulcers, local infections, diabetic foot relapse.
Assuntos
Humanos , Masculino , Feminino , Adulto , Pessoa de Meia-Idade , Idoso de 80 Anos ou mais , Pé Diabético/epidemiologia , Pé Diabético/etiologia , Pé Diabético/terapia , Amputação Cirúrgica/estatística & dados numéricos , Chile , Evolução Clínica , Estudos de Coortes , Estudos Longitudinais , Pé Diabético/mortalidade , Recidiva , Distribuição por Sexo , Taxa de SobrevidaRESUMO
El pie diabético es la principal causa de amputación y mortalidad en pacientes diabéticos. Objetivo: establecer la frecuencia de amputaciones y característica clínicas en pacientes con el diagnóstico de pie diabético hospitalizados en el Hospital Clínico de la Universidad de Chile entre 1985-2000. Evaluar posibles factores de riesgo y la mortalidad posterior al egreso. Pacientes y método: análisis de ficha clínica, obtención de la fecha y causa de muerte del Servicio de Registro Civil e Identificación. Resultados: De 278 pacientes a 193 (69.4 por ciento) se les realizó una amputación. El nivel anatómico se distribuyó de la siguiente manera: 46 por ciento ortejo, 20 por ciento transmetatarsiana, 17 por ciento infracondílea y 17 por ciento supracondílea. Resultaron factores de riesgo para amputación: antecedente de amputación anterior (odds ratio [OR] 1.95, 95 por ciento IC 1.1-3.4); linfopenia ([OR] 0.96, 0.93-0.98); VHS aumentada ([OR] 1.012, 1.0044-1.02) y la presencia de retinopatía ([OR] 4.4, 2.2-9.1). La hospitalización fue más prolongada en los amputados (25 +/-22 vs 15 +/-13 días). El porcentaje de amputaciones en los períodos 1985 - 1994 y 1995 - 2000 fue similar (67 por ciento vs 70 por ciento). Un 35 por ciento de los pacientes amputados y un 52 por ciento de los no amputados fallecieron en un promedio de 3.38 años (rango 0-15.5 y 0-11.8 respectivamente). La primera causa de muerte en el grupo no amputado fue la cardiovascular y en el grupo amputado, fue la causa séptica. Conclusiones: aún existe una elevada frecuencia de amputaciones por pie diabético en nuestro medio lo que se asocia a hospitalizaciones prolongadas. El pie diabético complicado determina una elevada mortalidad antes de los 5 años del egreso.
The diabetic foot is the main cause of amputation and mortality in diabetic patients. Aim: To determine the frequency of lower extremity amputations and clinical features in patients with the diagnosis of diabetic foot assisted at the University of Chile Clinical Hospital between 1985-2000 to determine risks factors and mortality after the discharge. Patients and Method: Analysis of patient records and obtainment of the date and cause of death from the National Register of Citizens. Results: Of 278 patients 193 patients (69.4 percent) underwent an amputation. The anatomic level was: 46 percent toe; 20 percent transmetatharsal; 17 percent under the knee and 17 percent over the knee. Risk factors for amputation were: history of amputation (odds ratio [OR] 1.95, 95 percent IC 1.1-3.4); low lymphocytes count ([OR] 0.96, 0.93-0.98); high eritro sedimentation rate ([OR] 1.012, 1.0044-1.02) and retinopathy ([OR] 4.4, 2.2-9.1). Longer hospitalizations were observed in amputee patients (25 +/- 22 vs 15 +/- 13 days). A similar frequency of amputations was observed between 1985-1994 and 1995-2000 periods. A 35 percent of amputee patients and 52 percent of non amputee patients died in a mean of 3.34 years after the event (range 0-15.5 y 0-11.8 respectively). Among non amputee patients the main cause of death was cardiovascular disease and infectious processes were the main cause in amputee patients. Conclusions: A high frequency of amputations because diabetic foot is still observed in our diabetic patients that is associated to longer hospitalizations. The complicated diabetic foot determines a high mortality before 5 years of the event.
Assuntos
Humanos , Masculino , Feminino , Amputação Cirúrgica , Complicações do Diabetes/mortalidade , Pé Diabético/complicações , Pé Diabético/mortalidade , Pé Diabético/patologia , Análise de Sobrevida , ChileRESUMO
Introducción: el impacto de la Clínica del Pie del Diabético (CPD) se ve reflejado en la disminución de las lesiones del pie, las amputaciones, la estancia hospitalaria, la morbilidad y la mortalidad.Objetivo: determinar el impacto que tiene sobre los factores que afectan la tasa y el nivel de cercenamiento después de una amputación primaria de ortejo. Diseño: estudio comparativo, observacional, transversal, con seguimiento de dos años.Ubicación: Centro Médico Nacional "Adolfo Ruiz Cortines", Instituto Mexicano del Seguro Social.Muestra: pacientes amputados de un ortejo entre el 1 de agosto de 1997 y el 30 de enero de 1998. Se integraron dos grupos: A (n = 20), constituido por quienes siguieron las instrucciones recibidas en la CPD; y B (n = 14), individuos que abandonaron la CPD.Resultados: el porcentaje de curación de las lesiones fue superior en el grupo A comparado con el B (50 por ciento versus 14.2 por ciento). En el B, 85.9 por ciento requirió reamputación por lesión contralateral, mientras que en el A dicho evento disminuyó 57 por ciento. La lesión contralateral se presentó en pacientes con mayor edad (66 años; p < 0.05); también la edad se correlacionó positivamente con el número de amputaciones y el nivel quirúrgico (r = 0.95 y r = 0.76, respectivamente). Sin defunciones en el grupo A, la mortalidad del B fue de 7.5 por ciento.Discusión: aunque la edad se correlacionó positivamente con la lesión contralateral, número y nivel de amputación, la CPD aumentó la curación de las lesiones y disminuyó la necesidad de amputación, sin ninguna defunción. Conclusiones: la CPD incrementó la curación de las úlceras y abolió las defunciones. La atención integral debe enfocarse a la prevención de lesión contralateral asociada a una edad mayor.
Assuntos
Humanos , Masculino , Feminino , Pessoa de Meia-Idade , Previdência Social , Diabetes Mellitus , Amputação Cirúrgica/efeitos adversos , Amputação Cirúrgica/métodos , Pé Diabético/cirurgia , Pé Diabético/epidemiologia , Pé Diabético/mortalidade , Estudos de Coortes , Pé Diabético/prevenção & controleRESUMO
Introducción: tradicionalmente las amputaciones de ortejos por pie diabético se realizan en el quirófano con incremento en los costos de atención. No encontramos antecedentes que validen la realización del procedimiento en el domicilio.Métodos: en el periodo del 1 de agosto de 1997 al 30 de enero de 1998, se comparó retrospectivamente la morbilidad y mortalidad de pacientes con infección y necrosis de ortejos amputados en el domicilio (grupo 1; n = 14), en el consultorio (grupo 2; n = 11) y en el hospital (grupo 3; n = 20). Análisis estadístico: para variables nominales se usó Ji cuadrada o prueba exacta de Fisher y para las continuas ANOVA o Kruskal-Wallis.Resultados: las características demográficas y clínicas (edad, sexo, años de evolución de la diabetes, semanas de evolución de la lesión, número de ortejos amputados, pie afectado, enfermedad asociada y complicaciones crónicas) fueron similares en los grupos de estudio (p > 0.05). Las complicaciones y el nivel de reamputación en los pacientes complicados fueron independientes del lugar del procedimiento (p > 0.05). Sin nueva lesión o reamputación en el grupo domiciliario, un paciente del segundo requirió reamputación mayor por insuficiencia arterial. Ocho pacientes hospitalizados (grupo 3) con lesión fueron reamputados por problema vascular (p > 0.05). No se presentaron defunciones. Discusión: las amputaciones digitales realizadas en el domicilio, el consultorio o la cama del paciente mostraron evolución clínica similar, dentro de un programa de atención integral, por lo que son una opción en pacientes seleccionados.
Assuntos
Humanos , Masculino , Feminino , Pessoa de Meia-Idade , Amputação Cirúrgica/métodos , Dedos , Instalações de Saúde , Pé Diabético/complicações , Complicações Pós-Operatórias , Tratamento Domiciliar , Diabetes Mellitus , Pé Diabético/mortalidadeRESUMO
El pie diabético es una complicación frecuente en la evolución de los pacientes diabéticos mal controlados. En el presente estudio se cuantifica su incidencia como causa de ingreso a la Unidad de Emergencia del Hospital Luis Vernaza; se analizan ciertas variables como edad, sexo, tipo de tratamiento y mortalidad. Se observa que es alta su incidencia en relación a otras causas de ingresos de diabéticos al área de emergencia; que es más frecuente en el sexo masculino por arriba de los 30 años; que la mortalidad es baja en relación con otras causas de ingresos de pacientes diabéticos y que lamentablemente se está practicando una terapéutica muy agresiva que deja como consecuencia incapacidad funcional en el 67 por ciento...
Assuntos
Neuropatias Diabéticas , Incidência , Pé Diabético/mortalidade , Pé Diabético/terapia , Equador , HospitaisRESUMO
The contents of the manual reflect the comprehensive review of the problem which was undertaken at the meeting. In the first section, the phenomenon of the diabetic foot is defined and various mechanisms involved in its pathogenesis are described in detail. The commonly seen foot lesions are conveniently categorised and their management described in succint and precise fashion. Preventative measures are outlined; these include steps to be taken to either prevent or retard the development of the neuropathic and vascular processes, which make the foot so vulnerable to infections and trauma, as well as the measures to be adopted for the proper care of the vulnerable foot. The second section of the manual is made up of the papers which were presented at the meeting by members of the Study Group. They contain a wealth of information on several aspects of the diabetic foot and include data on the Caribbean experience of the problem (Preface)