Faculty Collaboration Database

Developing and validating a risk score for lower-extremity amputation in patients hospitalized for a diabetic foot infection. Diabetes Care 2011 Aug;34(8):1695-700

Date

06/18/2011

Pubmed ID

21680728

Pubmed Central ID

PMC3142050

DOI

10.2337/dc11-0331

Scopus ID

2-s2.0-84862833632 (requires institutional sign-in at Scopus site)   89 Citations

Abstract

OBJECTIVE: Diabetic foot infection is the predominant predisposing factor to nontraumatic lower-extremity amputation (LEA), but few studies have investigated which specific risk factors are most associated with LEA. We sought to develop and validate a risk score to aid in the early identification of patients hospitalized for diabetic foot infection who are at highest risk of LEA.

RESEARCH DESIGN AND METHODS: Using a large, clinical research database (CareFusion), we identified patients hospitalized at 97 hospitals in the U.S. between 2003 and 2007 for culture-documented diabetic foot infection. Candidate risk factors for LEA included demographic data, clinical presentation, chronic diseases, and recent previous hospitalization. We fit a logistic regression model using 75% of the population and converted the model coefficients to a numeric risk score. We then validated the score using the remaining 25% of patients.

RESULTS: Among 3,018 eligible patients, 21.4% underwent an LEA. The risk factors most highly associated with LEA (P < 0.0001) were surgical site infection, vasculopathy, previous LEA, and a white blood cell count >11,000 per mm(3). The model showed good discrimination (c-statistic 0.76) and excellent calibration (Hosmer-Lemeshow, P = 0.63). The risk score stratified patients into five groups, demonstrating a graded relation to LEA risk (P < 0.0001). The LEA rates (derivation and validation cohorts) were 0% for patients with a score of 0 and ~50% for those with a score of ≥21.

CONCLUSIONS: Using a large, hospitalized population, we developed and validated a risk score that seems to accurately stratify the risk of LEA among patients hospitalized for a diabetic foot infection. This score may help to identify high-risk patients upon admission.

Author List

Lipsky BA, Weigelt JA, Sun X, Johannes RS, Derby KG, Tabak YP

MESH terms used to index this publication - Major topics in bold

Aged
Diabetic Foot
Female
Hospitalization
Humans
Logistic Models
Lower Extremity
Male
Middle Aged
Reproducibility of Results
Risk Factors