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Complications of Lower Extremity Amputation in Diabetes Patients

Study finds affected patients at increased risk of CVD, chronic kidney disease and death…

Diabetes patients with lower extremity amputation are more likely to die from other complications such as cardiovascular disease (CVD) and chronic kidney disease, and to have more lower extremity amputation (LEA) than other diseases.

The purpose of this study was to fully explain if diabetes patients with lower extremity amputation were associated with a higher rate of death, and as well as well-known death complication such as CVD and renal failure. The authors performed a longitudinal cohort study of patients cared for in The Health Improvement Network primarily in LEA and outcome was all-cause death. Cox proportional hazards models was used to estimate the effect of LEA on death. Risk factor variables consisted of patients with a history of cardiovascular disease, Charlson index and a history of chronic kidney disease.

The authors found that the hazard ratio (HR) of death to be 3.02 after a lower extremity amputation, and a decrease approximately by 22% to 2.37 in a fully adjusted lower extremity amputation hazard ratio, which includes all risk factor variables. The area under the receiver operating-curve (AUC) of 0.51 is poorly predictive, and was fully adjusted with an AUC of 0.77, which was better.

The authors concluded that patients with diabetes and lower extremity amputation are more likely to die compared to those without lower extremity amputation. According to the study, while some of this variation can be explained by known complications of diabetes, there remains a large amount of unexplained variation.

Practice Pearls:

  • Lower extremity amputation may lead to CVD, chronic kidney disease and death.
  • More study is needed to further investigate the remaining variables.

Hoffstad, Ole, Nandita Mitra, Jonathan Walsh, and David J. Margolis. “Diabetes, Lower-Extremity Amputation, and Death.” Diabetes Care (2015): Dc150536.