Predictive Factors for Limb Salvage — The Singapore Experience

Major amputation resulting from a diabetic foot problem poses not only serious emotional burden but also serious mortality issues. Indeed amputation leads to loss of life. It is therefore imperative to avoid limb loss at all costs. This requires all diabetics to undergo annual foot screening and foot care to address the “foot at risk” promptly. Several research workers have studied the role of various factors as predictive factors for limb loss. The authors compare and discuss their results in evaluating predictive factors in a cohort of 202 diabetics with those of other co-workers.

With univariate analysis, predictive factors were found to be age above 60, co-morbidities like stroke and ischaemic heart disease, complications of diabetes including nephropathy, peripheral vascular disease and sensory neuropathy HbA1C level > 7%, ankle brachial index (ABI) < 0.8, foot problems such as gangrene and infection and pathogens such as MRSA and Staphylococcus aureus. With stepwise logistic regression, only peripheral vascular disease and infection were found to be significant.