European Journal of Cardiovascular Medicine

Prospective observational study, to formulate a risk scoring system that can predict the risk of amputation in a patient with an infected diabetic foot in patients presenting to the OPD and IPD of Katuri medical college &hospital, Chinakondrupadu, Guntur. Atotalof203patients in the duration from December 1st, 2020, to June 1st, 2022 presented with infected diabetic foot ulcerto our hospital, of which150 were enrolled in the study.

Using the specificity and sensitivity of our 11 risk factors, we constructed a ROC curve according to which our new Risk score had a high prognostic accuracy based on the area under the curve of 0.903, which was higher  than  the International Working Group on the Diabetic Foot (IWGDF) system which was 0.67. The Resultant ROC curve yielded a cut off score of 16.5.

Our study found the risk of amputation increases with the severity of the infection reflected in our study, with the highest incidence rate of 44.7%ofamputations belonged to IDSA grade4. An association between HbA1c levels and Lower extremity amputation can be drawn, with the maximum number of amputations identified in patients with HbA1c≥9.5. A strong correlation between the previous history of diabetic Lower extremity amputation and present amputation. 77.8% of patients who had a history of lower extremity amputation due to diabetes underwent amputations. 68.1 % of patients who underwent amputations had sensory neuropathy in ≥3sites.

A total of 9 patients required re amputation and 26 patients who were our previous amputee subjects required re debridement within a period of 18 months. All the patients who underwent re amputation had a score of>16.5.

Thus our score predicted the need for future amputation in those patients who had a Score of > 16.5.

Limitations of our study are:

1. The effect of our risk factors on major and minor amputations separately were not assessed.
2. The history of the previous lower extremity revascularization procedure was not taken into account while calculating the score.
3. The effects of venous insufficiency on diabetic foot ulcers in this study were not accounted for.
4. The motor neuropathy was not segregated into subsequent grades based on the muscle power

The effects of type 1 and type 2 diabetes was not studied independently