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AN OBSERVATIONAL RESEARCH TO EVALUATE PREDICTING POSSIBILITIES OF DIABETIC FOOT ULCERS THROUGH LABORATORY AND CLINICAL BASELINE PARAMETERS

Dr Ayesha Sarwar, Dr. Manzara Mudassar, Dr Rabia Khalid

Objective: Diabetic foot ulcer prediction is helpful for disease management and clinicians. The objective of this research is to examine the predicting possibilities of diabetic foot ulcer patients by evaluating laboratory and clinical baseline parameters. Patients and Methods: We carried out this observational research at Jinnah Hospital, Lahore from November 2017 to August 2018 on a total of 574 foot ulcer episodes to evaluate amputation predictors. Patients were followed-up for a period of six months. Results: Osteomyelitis, Limb ischemia, gangrene and ulcer depth were determined with the help of Wagner Classification. These were major predictors of overall amputations and major amputations. Older age, coronary artery disease, ulcer size and smoking were also associated with both overall amputations and major amputations. Baseline acute phase reactants levels (polymorphonuclear leukocyte count, white blood cell count, erythrocyte sedimentation rate (ESR), platelet count, albumin and serum C-reactive protein (CRP)) and reduced levels of haemoglobin were associated with the risk of amputation. It was learned through multivariate analysis that increase of one standard deviation in ESR & CRP baseline levels predicted both overall amputations and major amputations. Conclusions: Limb ischemia, local gangrene, diffuse gangrene, osteomyelitis and ulcer depth independently predict amputation. Baseline parameters of CRP and ESR are helpful for amputation prediction for the clinicians. Keywords: Amputation, Acute Phase Reactants, Diabetes, Ischemia, Foot Ulcer and Osteomyelitis.

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