BACKGROUND: The complex pathophysiology of diabetic foot lesions results from a triad of ischemia, neuropathy and infection.12 In the United States, diabetic foot lesions are the underlying cause of two-thirds of major amputations. A retrospective study was conducted among patients with diabetic foot lesions admitted at the Philippine Heart Center to determine the risk factors for amputation and mortality. Thirty nine adult diabetic patients admitted for diabetic foot lesions from 1998 to 2003 were included in the study. On statistical analysis, the following factors were found to be associated with amputation: prolonged duration of foot lesions; Grade V Wagner's classification of diabetes mellitus (DM) foot lesions; and higher white blood cell (WBC) count. Other factors, such as age on presentation, sex, smoking history and CBG on admission were not significantly associated with amputation. On further analysis comparing risk factors between those who died (4) while admitted and those who went home alive (35), the following were associated with the former: more prolonged duration of DM, history of renal insufficiency and history of coronary artery disease (CAD). All of those who died had sepsis as their underlying cause of death. Bacteriologic analysis of specimen obtained during admission and perioperatively yielded 25 isolates, the most common of which were E. coli, Klebsiella pneumoniae and Staphylococcus coagulase negative. Most of the gram-positive isolates were resistant to Penicillin and Oxacillin, while most of the gram-negative isolates are sensitive to Ciprofloxacin.
We have noted significant associated risk factors in the amputated group as well as those who died while in the hospital. For logistic regression analysis to be done, additional samples are needed. (Author)