Prevalence and Correlates of Lower-Extremity Amputation in Patients With Diabetic Foot Ulcer in Jeddah, Saudi Arabia

Abstract

This cross-sectional study investigated the prevalence and correlates of lower-extremity amputation (LEA) in a Saudi population with diabetic foot ulcer. The study population consisted of 91 participants, with a median age of 55.0 years. Biomarkers were measured following standard protocols. Local symptoms of foot ulcer, including peripheral neuropathy (PN), peripheral artery disease (PAD), and foot infection were diagnosed by standard objective diagnostic tools or diagnosed clinically by a specialized surgeon. The severity of foot ulcer was classified according to the Wagner wound classification system. The prevalence of LEA was 29.7% in this population. The odds ratio for LEA comparing extreme tertiles was 2.42 (95% confidence interval [CI] = 0.70-8.45; P for trend = .03) for ulcer size and 0.22 (95% CI = 0.06-0.87; P for trend = .03) for high-density lipoprotein cholesterol. C-reactive protein and homocysteine levels were each positively associated with odds of LEA, but the associations became nonsignificant in multivariable models. Participants with foot infection showed a significantly higher adjusted prevalence of LEA (40.7%, 95% CI = 27.1%-54.3%) compared with those without foot infections (19.3%, 95% CI = 6.0%-32.4%, P = .03). Participants with Wagner grade ≥3 presented a significantly higher prevalence (40.5%, 95% CI = 27.8%-53.2%) than those with Wagner grade of 1 or 2 (16.4%, 95% CI = 2.4%-30.5%, P = .02). Participants with PN and PAD showed nonsignificantly higher prevalence of LEA. We found a relatively high prevalence of LEA as well as several clinical markers and local symptoms associated with LEA in this Saudi population with diabetic foot ulcer.