Diyabetik Ayak Enfeksiyonu Olan Hastalarda Ampütasyon Sıklığı ve Ampütasyonla İlişkili Risk Faktörlerinin Belirlenmesi

Giriş: Diyabetik ayak enfeksiyonları (DAE) diabetes mellitusun sık bir komplikasyonu olup %15-20’si ampütasyon ile sonuçlanmaktadır. Bu grup hastalarda ampütasyona predispozisyon oluşturan risk faktörlerinin saptanması ampütasyonu önleyici tedbirlerin alınması ve gerekli medikal tedavilerin planlanmasına yardımcı olabilir. Bu çalışmada kliniğimizde son beş yılda takip edilen DAE olan hastalarda ampütasyon sıklığı ve ampütasyonla ilişkili risk faktörlerinin belirlenmesi amaçlanmıştır. Gereç ve Yöntem: Çalışmamız retrospektif tanımlayıcı bir çalışmadır. Hastalar ampütasyon uygulanma durumuna göre iki gruba ayrılarak yaş, cinsiyet, diyabet süresi, antidiyabetik tedavi, Wagner yara sınıflaması, yara genişliği, yara süresi, periferik arter hastalığı (PAH), hipertansiyon (HT), kronik böbrek yetmezliği, osteomyelit (OM), ampütasyon geçmişi, hiberbarik oksijen tedavisi uygulanması, toplam antimikrobiyal tedavi süresi, tedavi öncesinde ateş varlığı, lökosit, sedimantasyon, C-reaktif protein, kreatinin, HBA1c düzeylerine göre karşılaştırılmıştır. Ampütasyon sıklığı hesaplanıp, daha sonra ampütasyon uygulanan ve uygulanmayan gruplar arasında tek değişkenli ve çok değişkenli lojistik regresyon testleri ile bağımsız risk faktörleri belirlenmiştir. Bulgular: Çalışmaya dahil edilen 146 hastada ampütasyon sıklığı %39,7 olarak saptanmıştır. Wagner yara sınıflaması skoru >2 olanlar, PAH, HT, OM bulunanlar ve lökosit, C-reaktif protein, sedimantasyon düzeyi yüksek saptananlar ile yara genişliği 11-15 cm2 arasında olan olgularda ampütasyonun daha sık olduğu tespit edilmiştir. Bu faktörlerden Wagner yara sınıflaması skoru ≤2 olması ve PAH bulunmamasının ampütasyon riskini azalttığı, yaranın 11-15 cm2 arasında olmasının ise ampütasyon riskini 8,2 kat artırdığı belirlenmiştir. Sonuç: DAE olan hastalarda ekstremite kaybını önleyebilmek için dolaşım probleminin hızla çözümlenmesi, yaranın daha yüzeyel ve yüzey alanı olarak daha küçük olduğu erken dönemde tedavinin yapılması uygun bir yaklaşım olabilir.

Determination of Amputation Prevalence and Risk Factors Related to Amputation in Patients With Diabetic Foot Infection

Objectives: Diabetic foot infections (DFI) are a frequent complication of diabetes mellitus and 15-20% of them result in amputation. Identifying the risk factors that predispose to amputation in this group of patients can help prevent amputation and plan the appropriate medical treatments. In this study, we aim to determine amputation frequency and risk factors related to amputation in patients with DFI, who were followed up in our clinic in the last five years. Materials and Methods: Our study is a retrospective descriptive study. Patients were divided into two groups according to the amputation application. Age, gender, duration of diabetes, antidiabetic therapy, Wagner classification, wound width, wound time, peripheral artery disease (PAD), hypertension (HT), chronic kidney failure, osteomyelitis (OM) history, hyperbaric oxygen therapy application, total antimicrobial treatment duration, presence of fever before treatment, leukocyte, sedimentation, C-reactive protein, creatinine, and HBA1c levels were compared. The frequency of amputation was calculated, and independent risk factors were determined between univariate and multivariate logistic regression tests between the groups with and without amputation. Results: The frequency of amputation was found to be 39.7% in 146 patients included in the study. It was found that amputation was more common in patients with Wagner wound classification score >2, with PAD, HT, OM, and in patients with a leukocyte, C-reactive protein, high sedimentation level, and wound width 11-15 cm2. It was determined that the Wagner wound classification score ≤2 and absence of PAD reduced these factors, and that the wound between 11 and 15 cm2 increased the risk of amputation by 8.2 times. Conclusion: In order to prevent limb loss in patients with DFI, it may be a suitable approach to resolve the circulation problem rapidly and to treat in the early period when the wound is more superficial and smaller in terms of surface area.

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