Highlights
- •Median time-to-(being)-ulcer-free in 4,709 DFU patients was 112 days and 68.4% were ulcer-free within two years.
- •Each year younger than 60 years was independently associated with longer time-to-ulcer-free.
- •PAD and ulcer size were associated with longer time-to-ulcer-free but only for 6 months.
- •Podiatry and knee-high offloading treatment were associated shorter time-to-ulcer-free.
- •Probability of being ulcer-free was largest for geographical remoteness and PAD factors.
Abstract
Aims
To investigate factors independently associated with time-to-(being)-ulcer-free, time-varying
effects and predict adjusted ulcer-free probabilities, in a large prospective cohort
with diabetes-related foot ulcers (DFU) followed-up for 24 months.
Methods
Patients presenting with DFU(s) to 65 Diabetic Foot Services across Queensland, Australia,
between July-2011 and December-2017 were included. Demographic, comorbidity, limb,
ulcer, and treatment factors were captured at presentation. Patients were followed-up
until ulcer-free (all DFU(s) healed), amputation, death or two years. Factors associated
with time-to-ulcer-free were investigated using both Cox proportional hazards and
flexible parametric survival models to explore time-varying effects and plot predicted
adjusted ulcer-free probability graphs.
Results
Of 4,709 included patients (median age 63 years, 69.5% male), median time-to-ulcer-free
was 112 days (IQR:40->730), with 68.4% ulcer-free within two years. Factors independently
associated with longer time-to-ulcer-free were each year of age younger than 60 years,
living in a regional or remote area, smoking, neuropathy, peripheral artery disease
(PAD), ulcer size >1 cm2, deep ulcer and mild infection (all p < 0.05). Time-varying effects were found for PAD and ulcer size limiting their association
to six months only. Shorter time-to-ulcer-free was associated with recent DFU treatment
by a podiatrist and receiving knee-high offloading treatment (both p < 0.05). Predicted adjusted ulcer-free probability graphs reported largest differences
in time-to-ulcer-free over 24-months for geographical remoteness and PAD factors.
Conclusions
Multiple factors predicted longer and shorter time-to-ulcer-free in people presenting
with DFUs. Considering these factors, their time-varying effects and adjusted ulcer-free
probability graphs, should aid the prediction of the likely time-to-(being)-ulcer-free
for DFU patients.
Keywords
Abbreviations:
DFU (diabetes-related foot ulcer), PAD (peripheral artery disease), QHRFF (Queensland High Risk Foot Form), HR (hazard ratio), IQR (interquartile range), CI (confidence interval)To read this article in full you will need to make a payment
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Article info
Publication history
Published online: February 03, 2022
Accepted:
February 1,
2022
Received in revised form:
January 27,
2022
Received:
September 14,
2021
Identification
Copyright
© 2022 Elsevier B.V. All rights reserved.
