Objective To retrospectively analyze the clinical features and treatment outcomes of patients with diabetic foot ulcers (DFU), and to investigate the effect of controlling nutritional status (CONUT) scores on the amputation risks and hospital length-of-stay of DFU patients.
Methods A total of 357 DFU inpatients admitted to the Department of Endocrinology, PLA Strategic Support Force Characteristic Medical Center between January 1, 2016 and December 31, 2018 were enrolled and analyzed retrospectively. Based on their CONUT scores, the patients were divided into 3 groups, a normal nutritional status group consisting of patients with CONUT scores 0-1 (n=100), a mild malnutrition group consisting of patients with CONUT scores 2-4 scores (n=164), and a moderate-to-severe malnutrition group consisting of patients with CONUT scores≥5 (n=93). According to whether they underwent amputation, patients were divided into an amputation group (n=110) and a non-amputation group (n=247). The clinical characteristics, amputation rate, and hospital length-of-stay were compared between groups with different CONUT scores. Logistic regression was conducted to analyze the independent risk factors of amputation.
Results The total amputation rate of DFU patients was 30.6%. Among all amputations, the major amputation (above-the-ankle amputation) rate was 1.8%, and the minor amputation rate was 98.2%. The amputation rate in patients with mild and moderate-to-severe malnutrition were 1.5 and 3.0 times higher than those in the normal nutritional status group, respectively. Logistic regression analysis showed that the moderate-to-severe nutritional status (5-12 scores), white blood cell, Wagner classification and ankle-brachial index were independent risk factors for amputation.
Conclusion CONUT score is closely associated with amputations in DFU patients. Improving the nutritional status of patients in the early stage could reduce the risk of amputation.
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