Medicina

Diabetologia (2008) 51:747–755 DOI 10.1007/s00125-008-0940-0

ARTICLE

Prediction of outcome in individuals with diabetic foot ulcers: focus on the differences between individuals with and without peripheral arterial disease. The EURODIALE Study
L. Prompers & N. Schaper & J. Apelqvist & M. Edmonds & E. Jude & D. Mauricio & L. Uccioli & V. Urbancic & K. Bakker & P. Holstein & A. Jirkovska &A. Piaggesi & G. Ragnarson-Tennvall & H. Reike & M. Spraul & K. Van Acker & J. Van Baal & F. Van Merode & I. Ferreira & M. Huijberts

Received: 1 October 2007 / Accepted: 3 January 2008 / Published online: 23 February 2008 # The Author(s) 2008

Abstract Aims/hypothesis Outcome data on individuals with diabetic foot ulcers are scarce, especially in those with peripheral arterial disease (PAD).We therefore examined the clinical characteristics that best predict poor outcome in a large population of

diabetic foot ulcer patients and examined whether such predictors differ between patients with and without PAD. Methods Analyses were conducted within the EURODIALE Study, a prospective cohort study of 1,088 diabetic foot ulcer patients across 14 centres in Europe. Multiple logistic

L.Prompers (*) : N. Schaper : M. Huijberts Division of Endocrinology Department of Internal Medicine, University Hospital Maastricht, P. Debeyelaan 25, P.O. Box 5800, 6202 AZ Maastricht, the Netherlands e-mail: Leonne.Prompers@intmed.unimaas.nl J. Apelqvist Department of Endocrinology, University of Malmö, Malmö, Sweden M. Edmonds Diabetic Department, Kings College Hospital, London, UK E. JudeDiabetes Centre, Tameside General Hospital, Ashton-under-Lyne, UK D. Mauricio Department of Endocrinology & Nutrition, Hospital de Sant Pau, Autonomous University of Barcelona, Barcelona, Spain L. Uccioli Policlinico Tor Vergata, Department of Internal Medicine, Rome, Italy

V. Urbancic Department of Endocrinology, University Medical Centre, Ljubljana, Slovenia K. Bakker IDF Consultative Section andInternational Working Group on the Diabetic Foot, Heemstede, the Netherlands P. Holstein Copenhagen Wound Healing Centre, Bispebjerg Hospital, Copenhagen, Denmark A. Jirkovska Diabetes Centre, Institute for Clinical and Experimental Medicine, Prague, Czech Republic A. Piaggesi U. O. Semplice Piede Diabetico, Dipartimento di Endocrinologia e Metabolismo, Azienda Ospedaliera Universitaria Pisana,Pisa, Italy G. Ragnarson-Tennvall Swedish Institute for Health Economics (IHE), Lund, Sweden

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Diabetologia (2008) 51:747–755

regression modelling was used to identify independent predictors of outcome (i.e. non-healing of the foot ulcer). Results After 1 year of follow-up, 23% of the patients had not healed. Independent baseline predictors of non-healing in the whole study populationwere older age, male sex, heart failure, the inability to stand or walk without help, end-stage renal disease, larger ulcer size, peripheral neuropathy and PAD. When analyses were performed according to PAD status, infection emerged as a specific predictor of nonhealing in PAD patients only. Conclusions/interpretation Predictors of healing differ between patients with and without PAD, suggesting thatdiabetic foot ulcers with or without concomitant PAD should be defined as two separate disease states. The observed negative impact of infection on healing that was confined to patients with PAD needs further investigation. Keywords Co-morbidities . Diabetes . Foot ulcer . Infection . Non-healing . Outcome . Peripheral arterial disease . Predictive model Abbreviations ABPI ankle–brachial pressureindex ESRD end-stage renal disease NYHA New York Heart Association OR odds ratio PAD peripheral arterial disease PNP peripheral neuropathy

Introduction Diabetic foot ulcers are a common and much feared complication of diabetes, with recent studies suggesting that the lifetime risk of developing a foot ulcer in diabetic patients may be as high as 25% [1]. Foot ulceration requires long and...