Background and Objective: Diabetic foot ulcers (DFUs) are a major complication of diabetes and frequently lead to hospitalization, amputation, and recurrence. This study aimed to identify predictors of amputation and recurrence among hospitalized patients with DFUs.
Methods: This descriptive-analytical study reviewed the medical records of 224 patients (123 men and 101 women; mean age, 59.3±3.11 years) hospitalized with DFUs. Extracted variables included age, sex, ethnicity, occupation, duration of diabetes, interval from diabetes diagnosis to ulcer development, smoking status, ulcer severity at admission (Wagner grade), treatments received (antibiotics, debridement, and amputation), recurrence frequency, and laboratory values at admission (Hb, WBC, ESR, CRP, and HbA1c). Primary outcomes were in-hospital amputation at any level and repeated recurrence of the original ulcer at the same site on two or more occasions.
Results: Wagner grades 2-5 predominated, with grade 2 being the most common. The rates of amputation and repeated recurrence were 31.3% and 40.2%, respectively. Higher hemoglobin levels were associated with lower odds of amputation (95% CI:0.52-0.86, OR=0.67, P<0.002), whereas higher WBC counts were associated with higher odds of this outcome (95% CI: 1.02-1.23, OR=1.12, P<0.018). Compared with Wagner grades 1 and 2, Wagner grade 4 (95% CI: 2.18-11.94, OR=5.10, P<0.001) and grade 5 (95% CI: 3.89-39.51, OR=12.40, P<0.001) were significantly associated with increased odds of amputation. Each 1-g/dL increase in hemoglobin was associated with significantly lower odds of recurrence (95% CI: 0.58-0.94, OR=0.74, P<0.012), whereas each 1×10^3/µL increase in WBC count was associated with significantly higher odds of recurrence (95% CI: 1.01-1.18, OR=1.09, P<0.026). Compared with Wagner grades 1-2, grade 4 (95% CI: 1.42-7.44, OR=3.25, P<0.005) and grade 5 (95% CI: 1.78-12.91, OR=4.80, P<0.002) were significantly associated with increased odds of recurrence. Smoking was also associated with increased odds of recurrence (95% CI: 1.05-3.63, OR=1.95, P<0.034).
Conclusion: Hemoglobin level, WBC count, Wagner grade, and smoking are key predictors of amputation and recurrence among patients with DFUs.