Does Perioperative Hemoglobin A1c Level Affect the Incidence, Pattern and Mortality of Lower Extremity Amputation?
Adult
Aged
Amputation, Surgical
/ adverse effects
Biomarkers
/ blood
Blood Glucose
/ drug effects
Diabetes Mellitus
/ blood
Female
Glycated Hemoglobin
/ metabolism
Humans
Hypoglycemic Agents
/ therapeutic use
Incidence
Lower Extremity
/ blood supply
Male
Middle Aged
Peripheral Arterial Disease
/ diagnosis
Prevalence
Qatar
/ epidemiology
Retrospective Studies
Risk Assessment
Risk Factors
Time Factors
Treatment Outcome
ADA
HbA1c
Lower extremities amputation
diabetes mellitus
hemoglobin
mortality.
Journal
Current vascular pharmacology
ISSN: 1875-6212
Titre abrégé: Curr Vasc Pharmacol
Pays: United Arab Emirates
ID NLM: 101157208
Informations de publication
Date de publication:
2019
2019
Historique:
received:
01
01
2018
revised:
14
05
2018
accepted:
14
06
2018
pubmed:
24
1
2018
medline:
19
5
2020
entrez:
24
1
2018
Statut:
ppublish
Résumé
We hypothesized that perioperative HbA1c influenced the pattern and outcomes of Lower Extremity Amputation (LEA). A retrospective analysis was conducted for all patients who underwent LEA between 2000 and 2013. Patients were categorized into 5 groups according to their perioperative HbA1c values [Group 1 (<6.5%), Group 2 (6.5-7.4%), Group 3 (7.5-8.4%), Group 4 (8.5-9.4%) and Group 5 (≥9.5%)]. We identified 848 patients with LEA; perioperative HbA1c levels were available in 547 cases (Group 1: 18.8%, Group 2: 17.7%, Group 3: 15.0%, Group 4: 13.5% and Group 5: 34.9%). Major amputation was performed in 35%, 32%, 22%, 10.8% and 13.6%, respectively. The overall mortality was 36.5%; of that one quarter occurred during the index hospitalization. Mortality was higher in Group 1 (57.4%) compared with Groups 2-5 (46.9%, 38.3%, 36.1% and 31.2%, respectively, p=0.001). Cox regression analysis showed that poor glycemic control (Group 4 and 5) had lower risk of mortality post-LEA [hazard ratio 0.57 (95% CI 0.35-0.93) and hazard ratio 0.46 (95% CI 0.31-0.69)]; this mortality risk persisted even after adjustment for age and sex but was statistically insignificant. The rate of LEA was greater among poor glycemic control patients; however, the mortality was higher among patients with tight control. The effects of HbA1c on the immediate and long-term LEA outcomes and its therapeutic implications need further investigation.
Sections du résumé
BACKGROUND
We hypothesized that perioperative HbA1c influenced the pattern and outcomes of Lower Extremity Amputation (LEA).
METHODS
A retrospective analysis was conducted for all patients who underwent LEA between 2000 and 2013. Patients were categorized into 5 groups according to their perioperative HbA1c values [Group 1 (<6.5%), Group 2 (6.5-7.4%), Group 3 (7.5-8.4%), Group 4 (8.5-9.4%) and Group 5 (≥9.5%)]. We identified 848 patients with LEA; perioperative HbA1c levels were available in 547 cases (Group 1: 18.8%, Group 2: 17.7%, Group 3: 15.0%, Group 4: 13.5% and Group 5: 34.9%). Major amputation was performed in 35%, 32%, 22%, 10.8% and 13.6%, respectively.
RESULTS
The overall mortality was 36.5%; of that one quarter occurred during the index hospitalization. Mortality was higher in Group 1 (57.4%) compared with Groups 2-5 (46.9%, 38.3%, 36.1% and 31.2%, respectively, p=0.001). Cox regression analysis showed that poor glycemic control (Group 4 and 5) had lower risk of mortality post-LEA [hazard ratio 0.57 (95% CI 0.35-0.93) and hazard ratio 0.46 (95% CI 0.31-0.69)]; this mortality risk persisted even after adjustment for age and sex but was statistically insignificant. The rate of LEA was greater among poor glycemic control patients; however, the mortality was higher among patients with tight control.
CONCLUSION
The effects of HbA1c on the immediate and long-term LEA outcomes and its therapeutic implications need further investigation.
Identifiants
pubmed: 29359671
pii: CVP-EPUB-88130
doi: 10.2174/1570161116666180123112529
doi:
Substances chimiques
Biomarkers
0
Blood Glucose
0
Glycated Hemoglobin A
0
Hypoglycemic Agents
0
hemoglobin A1c protein, human
0
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
354-364Informations de copyright
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