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      Prediction of outcome in individuals with diabetic foot ulcers: focus on the differences between individuals with and without peripheral arterial disease. The EURODIALE Study

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          Abstract

          Aims/hypothesis

          Outcome data on individuals with diabetic foot ulcers are scarce, especially in those with peripheral arterial disease (PAD). We therefore examined the clinical characteristics that best predict poor outcome in a large population of diabetic foot ulcer patients and examined whether such predictors differ between patients with and without PAD.

          Methods

          Analyses were conducted within the EURODIALE Study, a prospective cohort study of 1,088 diabetic foot ulcer patients across 14 centres in Europe. Multiple logistic regression modelling was used to identify independent predictors of outcome (i.e. non-healing of the foot ulcer).

          Results

          After 1 year of follow-up, 23% of the patients had not healed. Independent baseline predictors of non-healing in the whole study population were older age, male sex, heart failure, the inability to stand or walk without help, end-stage renal disease, larger ulcer size, peripheral neuropathy and PAD. When analyses were performed according to PAD status, infection emerged as a specific predictor of non-healing in PAD patients only.

          Conclusions/interpretation

          Predictors of healing differ between patients with and without PAD, suggesting that diabetic foot ulcers with or without concomitant PAD should be defined as two separate disease states. The observed negative impact of infection on healing that was confined to patients with PAD needs further investigation.

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          Most cited references 32

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          Multiple Imputation for Nonresponse in Surveys

           Rubin,  D. RUBIN,  DB Rubin (1987)
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            Regression With Missing X's: A Review

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              Peripheral arterial disease in patients with end-stage renal disease: observations from the Dialysis Outcomes and Practice Patterns Study (DOPPS).

              Patients with end-stage renal disease are at high risk for cardiovascular morbidity and mortality. The aims of the present study were to describe the prevalence of peripheral arterial disease (PAD) and its effects on prognosis and health-related quality of life (HRQOL) in an international cohort of patients on hemodialysis. Data from the Dialysis Outcomes and Practice Patterns Study (DOPPS), a prospective, international, observational study of hemodialysis patients (n=29,873), were analyzed. Associations between baseline clinical variables and PAD were evaluated by logistic regression analysis. Cox regression models were used to test the association between PAD and risk for all-cause mortality, cardiac mortality, and hospitalization. PAD was diagnosed in 7411 patients (25.3%) with significant geographic variation. Traditional cardiovascular risk factors including age, male sex, diabetes, hypertension, and smoking were identified, together with the duration of hemodialysis, as significant correlates of PAD. Diagnosis of PAD was associated with increased all-cause mortality (hazard ratio [HR]=1.36; P<0.0001), cardiac mortality (HR=1.43; P<0.0001), all-cause hospitalization (HR=1.19; P<0.0001), and hospitalization for a major adverse cardiovascular event (HR=2.05; P<0.0001). HRQOL questionnaires revealed physical health scores that were significantly lower in PAD compared with non-PAD patients (P<0.0001). PAD is common in hemodialysis patients and is associated with increased risk of cardiovascular mortality, morbidity, and hospitalization and reduced HRQOL.
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                Author and article information

                Contributors
                Leonne.Prompers@intmed.unimaas.nl
                Journal
                Diabetologia
                Diabetologia
                Springer-Verlag (Berlin/Heidelberg )
                0012-186X
                1432-0428
                23 February 2008
                May 2008
                : 51
                : 5
                : 747-755
                Affiliations
                [1 ]Division of Endocrinology Department of Internal Medicine, University Hospital Maastricht, P. Debeyelaan 25, P.O. Box 5800, 6202 AZ Maastricht, the Netherlands
                [2 ]Department of Endocrinology, University of Malmö, Malmö, Sweden
                [3 ]Diabetic Department, Kings College Hospital, London, UK
                [4 ]Diabetes Centre, Tameside General Hospital, Ashton-under-Lyne, UK
                [5 ]Department of Endocrinology & Nutrition, Hospital de Sant Pau, Autonomous University of Barcelona, Barcelona, Spain
                [6 ]Policlinico Tor Vergata, Department of Internal Medicine, Rome, Italy
                [7 ]Department of Endocrinology, University Medical Centre, Ljubljana, Slovenia
                [8 ]IDF Consultative Section and International Working Group on the Diabetic Foot, Heemstede, the Netherlands
                [9 ]Copenhagen Wound Healing Centre, Bispebjerg Hospital, Copenhagen, Denmark
                [10 ]Diabetes Centre, Institute for Clinical and Experimental Medicine, Prague, Czech Republic
                [11 ]U. O. Semplice Piede Diabetico, Dipartimento di Endocrinologia e Metabolismo, Azienda Ospedaliera Universitaria Pisana, Pisa, Italy
                [12 ]Swedish Institute for Health Economics (IHE), Lund, Sweden
                [13 ]Innere Abteilung, Mariannen Hospital, Werl, Germany
                [14 ]Diabetic Department, Mathias-Spital, Rhine, Germany
                [15 ]Department of Endocrinology, St Joseph Clinic, Bornen, Belgium
                [16 ]Department of Surgery, Twenteborg Ziekenhuis, Almelo, the Netherlands
                [17 ]Department of Health Organization, Policy and Economics, Maastricht University, Maastricht, the Netherlands
                [18 ]Department of Clinical Epidemiology & Medical Technology Assessment, University Hospital Maastricht, Maastricht, the Netherlands
                [19 ]Department of Internal Medicine, University Hospital Maastricht, Maastricht, the Netherlands
                Article
                940
                10.1007/s00125-008-0940-0
                2292424
                18297261
                © The Author(s) 2008
                Categories
                Article
                Custom metadata
                © Springer-Verlag 2008

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