2003 Volume 113 Issue 2 Pages 135-144
Background: Patients with diabetic foot gangrene usually have many other systemic diabetic complications, and occasionally have a poor vital prognosis. Purpose: To investigate the risk factors for the vital prognosis of gangrenous patients. Methods: Of 140 cases with diabetic foot gangrene who were treated in our institution from 1994 to 2001, 19 cases died. We retrospectively analyzed their clinical data and assessed the risk factors by the analysis of Kaplan-Meier survival curves and Cox regression model. Results: The 19 dead cases had poorly-controlled diabetes, and their mean HbAlc was 9.5%, which was higher than that of the 121 survivors (7.8%). They had more intensive foot gangrene and more serious diabetic complications including blindness as a result of retinopathy (2 cases) and long-term hemodyalysis due to nephropathy (11 cases). All the dead cases had severe arteriosclerosis obliterans, and 70% of them had undergone major limb amputation. These factors were statistically significantly different between the two groups. The most frequent causes of death were heart failure (5 cases) and sudden death (5 cases). Cox regression analysis demonstrated increased an risk ratio for the following three factors: major limb amputation (9.93, 95% confidence interval (95%CI) 3.48–28.30), HbAlc (1.61, 95% CI 1.26–2.05), age (1.10, 95% CI 1.02–1.19). Conclusion: According to these results, careful attention should be paid not only to the foot lesions but also to the control of diabetes and other systemic complications.