Zhang, Yuqi, Cramb, Susanna, McPhail, Steven, Pacella, Rosana ORCID: 0000-0002-9742-1957 , van Netten, Jaap J., Cheng, Qinglu, Derhy, Patrick, Kinnear, Ewan and Lazzarini, Peter (2022) Multiple factors predict longer and shorter time-to-ulcer-free in people with diabetes-related foot ulcers: Survival analyses of a large prospective cohort followed-up for 24-months. Diabetes Research and Clinical Practice, 185:109239. ISSN 0168-8227 (doi:https://doi.org/10.1016/j.diabres.2022.109239)

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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 >1cm2, 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.

Item Type:	Article
Uncontrolled Keywords:	cohort study; Cox proportional hazard model; diabetic foot ulcer; diabetes-related foot ulcer; flexible parametric survival model; ulcer-free
Subjects:	R Medicine > R Medicine (General) R Medicine > RB Pathology
Faculty / School / Research Centre / Research Group:	Faculty of Education, Health & Human Sciences Faculty of Education, Health & Human Sciences > Institute for Lifecourse Development Faculty of Education, Health & Human Sciences > Institute for Lifecourse Development > Centre for Chronic Illness and Ageing
Related URLs:	Publisher
Last Modified:	01 Jan 2024 01:38
URI:	http://gala.gre.ac.uk/id/eprint/35189

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