Predictive model of short-term amputation during hospitalization of patients due to acute diabetic foot infections | Enfermedades Infecciosas y Microbiología Clínica

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Moraga-Llop, Rosa Bartolomé, Nieves Larrosa, Magda Campins, Yuani Roman, Ana Vindel, Concepció Figueras" "autores" => array:8 [ 0 => array:2 [ "nombre" => "Marie Antoinette" "apellidos" => "Frick" ] 1 => array:2 [ "nombre" => "Fernando A." "apellidos" => "Moraga-Llop" ] 2 => array:2 [ "nombre" => "Rosa" "apellidos" => "Bartolomé" ] 3 => array:2 [ "nombre" => "Nieves" "apellidos" => "Larrosa" ] 4 => array:2 [ "nombre" => "Magda" "apellidos" => "Campins" ] 5 => array:2 [ "nombre" => "Yuani" "apellidos" => "Roman" ] 6 => array:2 [ "nombre" => "Ana" "apellidos" => "Vindel" ] 7 => array:3 [ "Iniciales" => "C." "nombre" => "Concepció" "apellidos" => "Figueras" ] ] ] ] ] "idiomaDefecto" => "es" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S0213005X10001928?idApp=UINPBA00004N" "url" => "/0213005X/0000002800000010/v1_201305090151/S0213005X10001928/v1_201305090151/es/main.assets" ] "en" => array:20 [ "idiomaDefecto" => true "cabecera" => "Original" "titulo" => "Predictive model of short-term amputation during hospitalization of patients due to acute diabetic foot infections" "tieneTextoCompleto" => true "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "680" "paginaFinal" => "684" ] ] "autores" => array:1 [ 0 => array:4 [ "autoresLista" => "José Barberán, Juan-José Granizo, Lorenzo Aguilar, Rafael Alguacil, Felipe Sainz, Maria-Antonia Menéndez, Maria-José Giménez, David Martínez, José Prieto" "autores" => array:9 [ 0 => array:5 [ "Iniciales" => "J." "nombre" => "José" "apellidos" => "Barberán" "email" => array:1 [ 0 => "josebarberan@teleline.es" ] "referencia" => array:2 [ 0 => array:2 [ "etiqueta" => "a" "identificador" => "aff1" ] 1 => array:2 [ "etiqueta" => "¿" "identificador" => "cor1" ] ] ] 1 => array:4 [ "Iniciales" => "J.J." 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"nombre" => "José" "apellidos" => "Prieto" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "c" "identificador" => "aff3" ] ] ] ] "afiliaciones" => array:5 [ 0 => array:3 [ "entidad" => "Infectious Diseases Department, Hospital Central de la Defensa Gómez Ulla, Madrid, Spain" "etiqueta" => "a" "identificador" => "aff1" ] 1 => array:3 [ "entidad" => "Granadatos, Demetrio de la Guerra 4, 28223 Pozuelo de Alarcon, Madrid, Spain" "etiqueta" => "b" "identificador" => "aff2" ] 2 => array:3 [ "entidad" => "Microbiology Department, School of Medicine, Universidad Complutense, Madrid, Spain" "etiqueta" => "c" "identificador" => "aff3" ] 3 => array:3 [ "entidad" => "Vascular Surgery Department, Hospital Central de la Defensa Gómez Ulla, Madrid, Spain" "etiqueta" => "d" "identificador" => "aff4" ] 4 => array:3 [ "entidad" => "Preventive Medicine Department, School of Medicine, Universidad Complutense, Madrid, Spain" "etiqueta" => "e" "identificador" => "aff5" ] ] "correspondencia" => array:1 [ 0 => array:3 [ "identificador" => "cor1" "etiqueta" => "⁎" "correspondencia" => "Corresponding author." ] ] ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Modelo de predicción de amputación temprana durante la hospitalización en pacientes ingresados por infección aguda de pie diabético" ] ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:7 [ "identificador" => "fig1" "etiqueta" => "Fig. 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 1450 "Ancho" => 1625 "Tamanyo" => 115458 ] ] "descripcion" => array:1 [ "en" => "Receiver operating characteristic (ROC) curve showing sensitivity and specificity (the oblique line represents the absence of predictive capability)." ] ] ] "textoCompleto" => "IntroductionApproximately 7.5% of persons with diabetes have a history of previous or active foot ulcer, and the lifetime risk of experiencing this condition is up to 15% in this population.<a class="elsevierStyleCrossRef" href="#bib1">1</a> Factors that precipitate a skin break or impair healing can lead to foot ulceration, putting the foot at risk. Peripheral neuropathy implies abnormal forces applied to the foot, lack of protective sensation, and deficient sweating, which leads to skin dryness. Ischemia renders the skin less able to withstand these factors. The coexistence of neuropathy, ischemia (the prevalence of peripheral vascular disease among diabetics is 10%), and leukocyte immune function disorders favors the development of severe, extensive infection,<a class="elsevierStyleCrossRef" href="#bib2">2</a> and infected foot wounds precede about two-thirds of amputations.<a class="elsevierStyleCrossRef" href="#bib3">3</a> In this regard, diabetic patients have a 10-fold greater risk of being hospitalized for bone and soft tissue infection of the foot than individuals without diabetes,<a class="elsevierStyleCrossRef" href="#bib3">3</a> and those with infected ischemic lesions have a 9-fold greater chance of undergoing amputation than those without ischemia or infection.<a class="elsevierStyleCrossRef" href="#bib4">4</a>This study investigates the predictive factors for amputation during hospital treatment of acute diabetic foot infections by comparing the clinical, laboratory, and imaging data at admission in patients who developed criteria for amputation with those who did not.Material and methodsA retrospective analysis of clinical records was performed in a cohort of 78 consecutive patients with diabetes type II who had not undergone a previous amputation. All patients had been admitted to the Infectious Disease Department or Vascular Surgery Department of Hospital Central de la Defensa Gomez Ulla in Madrid (Spain) over a 42-month period for acute diabetic foot infection. A clinical evaluation including neurological and vascular status was performed daily, and microbiological (culture of purulent drainage, curetted material, or aspiration of unopened abscesses), laboratory, and radiographic evaluations were carried out every 1 to 2 weeks during hospitalization, in keeping with the routine hospital practice. Noninvasive Doppler study was performed at admission, except when the patient presented good pedal and popliteal pulses and an absence of vascular lesions. Patients were assigned to one of the 6 grades (0–5) of the Wagner ulcer classification system.<a class="elsevierStyleCrossRefs" href="#bib5">5,6</a> Diabetic foot ulcers were classified into 3 groups: 1) neuropathic lesions: those present for months, surrounded by callus, occurring on the plantar aspect of a neuropathic foot (foot warm and well perfused with palpable pulses, decreased sweating, and sometimes, dry skin prone to fissuring), 2) ischemic lesions: those in an ischemic foot in the absence of neuropathy, and 3) mixed or neuro-ischemic lesions: presence of neuropathy and ischemia (foot cool, pulseless, presenting thin, shiny skin with no hair).Infection was defined by the presence of at least 3 of the following signs or symptoms: fever (≥38°C), leukocytosis (white blood cell count ≥10×103/mm3), local pain, tenderness, erythema, induration and/or presence of purulent secretion. Osteomyelitis was diagnosed by clinical criteria (bone exposure), radiological criteria (decrease in radiological density or cortical lyses in bone subjacent to soft tissue infection), and/or nuclear bone scan criteria (using technetium-99m methylene diphosphonate, gallium Ga 67 citrate, and indium-111-labeled white blood cells as tracers). Patients who underwent amputation at admission, pregnant patients, and those with life-threatening diseases (shock, hemodynamic alterations) or severe immunosuppression (oncological treatments) were excluded.In accordance with the hospital treatment protocol, patients were parenterally treated for at least 2 weeks with a third-generation cephalosporin plus metronidazole, or a quinolone plus clindamycin, or aztreonam plus clindamycin, together with concomitant surgical debridement, revascularization (bypass), sympathectomy, and/or reconstruction (skin graft) techniques. Patients who developed criteria for amputation during hospital treatment for diabetic foot infection underwent this type of surgery.For the data analysis, patients were divided into 2 groups: those who ultimately underwent amputation and those who did not. Clinical/epidemiological, laboratory, imaging, and treatment variables were comparatively analyzed between these 2 groups. The clinical/epidemiological variables recorded were gender, age, insulin use, duration of diabetes mellitus, diabetes comorbidities, previous foot lesions, main cause of foot wound, wound location, type of lesion, suppuration, odor, and lesion depth according to the Wagner classification. The laboratory data included white blood cell and platelet counts, hemoglobin, sedimentation rate, glycemia, creatinine concentration, and baseline microbiological culture. Imaging data consisted of alterations on radiography or nuclear bone scan, and lesion location and severity on arterial Doppler study (patients with normal Doppler features and those in whom Doppler was not performed because of good pedal and popliteal pulses and absence of vascular lesions were considered “normal”). Antimicrobial treatment and concomitant surgical techniques were also compared between groups.Data expressed in terms of frequency were analyzed using the chi-square test, and data expressed as mean±standard deviation, using the Student t-test, Mann-Whitney test or Wilcoxon test, when appropriate. A significance level of P≤0.05 was chosen.A logistic regression model was performed with amputation (yes/no) as the dependent variable and factors showing significant differences in the bivariate analysis as independent variables. The statistical analysis was performed with SPSS v14 (SPSS Inc., Chicago IL), choosing the “Introduce” command for the regression model. A scoring system was developed to predict amputation, using beta coefficients for significant variables in the regression analysis. The score was validated by receiver operating characteristic (ROC) curve analysis, determining the sensitivity and specificity for each cut-off. The greater the area of the ROC curve covering the theoretical square area, the greater the predictive capability.ResultsThe demographic, clinical and laboratory data at admission of patients included in this study, divided into the 2 analysis groups, are shown in <a class="elsevierStyleCrossRef" href="#tbl1">Table 1</a>. In the overall study population, mean age was 68.9±10.4 years, 57.7% were males, mean time of diabetes evolution was 14.9±8.5 years, and 50.0% of patients were receiving insulin treatment. There were no differences in these parameters when patients were divided into the 2 analysis groups.<elsevierMultimedia ident="tbl1"></elsevierMultimedia>The main cause of the foot wound was peripheral vasculopathy (70.5% patients), with no significant differences between the groups. However, a larger percentage of patients with peripheral vasculopathy (53.8% vs. 32.7%) and comorbid conditions (34.6% vs. 23.1%) were seen in the group ultimately requiring amputation than in the group that did not, although the differences were not statistically significant. A significantly higher percentage of patients had previous foot lesions (homolateral lesions in all cases) (P=0.001), higher leukocytosis (P=0.001), and higher sedimentation rate (P=0.002) in the group ultimately undergoing amputation.The characteristics of the lesions at admission are shown in <a class="elsevierStyleCrossRef" href="#tbl2">Table 2</a>. The most frequent wound location in both groups was the toes (53.8%). A significantly larger percentage of patients presenting necrosis (myonecrosis [gangrene] and/or necrotizing fasciitis), odor, and involvement of skin and soft tissue plus bone was found in the group requiring amputation, whereas a higher percentage of patients with suppuration and exclusive involvement of either bone or skin and soft tissue was found in the group that did not require amputation. Distribution of patients by Wagner ulcer classification showed grades 4 and 5 in 76.9% patients who underwent amputation and grade ≤3 in 84.6% of those who did not (P<0.001).<elsevierMultimedia ident="tbl2"></elsevierMultimedia>Samples for microbiological culture were taken in 56 patients, and 50 of them (89.2%) yielded bacterial growth. The infection was monomicrobial in 38% of cases (19 of 50), and polymicrobial in 62% of cases (31 of 50). Staphylococcus aureus was the most frequently isolated microorganism (40% of samples), followed by Staphylococcus epidermidis (19%), Klebsiella spp (8%), Pseudomonas aeruginosa (8%), Escherichia coli (6%), Enterococcus spp. (6%) and anaerobes (6%).Data on the imaging diagnosis and arterial Doppler at admission are shown in <a class="elsevierStyleCrossRef" href="#tbl3">table 3</a>. In the overall population, radiographs disclosed bone alterations in 56.4% patients and no alterations in 29.5%, with no differences when patients were divided into the 2 study groups. Nuclear bone scan was performed in 45 patients and 73.3% were positive, with no significant differences between the groups. Doppler study was carried out in 67 (85.9%) patients: 84.6% of those in the amputated group presented arterial obstruction, whereas stenosis was more frequent (57.7%) in the group without amputation (P<0.001).<elsevierMultimedia ident="tbl3"></elsevierMultimedia>No between-group differences were found with respect to antibiotic treatment: 20%, 40%, and 40% patients ending in amputation, and 23%, 50%, and 27% patients who did not, received third-generation cephalosporin plus metronidazole, aztreonam plus clindamycin, and quinolone plus clindamycin, respectively. Mean duration of treatment was 29.2±7.4 days, with no differences between the groups. With respect to concomitant surgical procedures, debridement, sympathectomy, bypass, and skin graft were performed in 88.5%, 3.8%, 3.8%, and 3.8% of patients ending in amputation and 90.4%, 1.9%, 3.8%, and 3.8% of the other patients, respectively. Mean time to amputation was 18.0±6.6 days.In the multivariate analysis, Wagner classification grades 4 and 5 showed a higher odds ratio (20.00, 95% CI 3.62–111.11; P=0.001) than reference grades 0–3, which was followed by arterial obstruction on Doppler (odds ratio=12.50; 95% CI=1.42–66.67; P=0.003), and the sedimentation rate (odds ratio=1.06; 95% CI=1.01–1.10; P=0.013). These 3 variables explained the best goodness of the fit (r2 Cox=0.522; P<0.001).Using exponentiation of the beta coefficients for significant variables (Doppler severity, DS [obstruction=3, stenosis/normal=1], Wagner grade, WG [grades 4 and 5=5; grades 0–3=1], and sedimentation rate, SR [100/crude sedimentation rate]) in the regression analysis, the predictive score was constructed as SCORE=DS+WG+SR. The score range was 2.01–8.78, and the area under curve in the ROC analysis was 0.93 (P<0.001) (<a class="elsevierStyleCrossRef" href="#fig1">Fig. 1</a>).<elsevierMultimedia ident="fig1"></elsevierMultimedia>A cut-off ≤2.31 showed 100% specificity and 37.5% sensitivity for no amputation, and a cut-off ≥8.38 showed 100% specificity and 46.2% sensitivity for amputation. The highest predictive value for amputation was obtained with a predictive score cut-off of 4.375 (sensitivity=96.2%; specificity=78.8%).DiscussionInfection is rarely implicated in the etiology of diabetic foot ulcers, but ulcers are susceptible to infection and for most of these patients, infection is a pivotal event that leads to limb complications, including amputation. Wound infections must be diagnosed clinically,<a class="elsevierStyleCrossRef" href="#bib7">7</a> and many risk factors for foot ulcers are also predisposing factors for amputation,<a class="elsevierStyleCrossRefs" href="#bib8">8,9</a> at a site where culture of wound material is usually not recommended<a class="elsevierStyleCrossRef" href="#bib10">10</a> and radiography is not a highly sensitive indicator of acute bone infection.<a class="elsevierStyleCrossRef" href="#bib11">11</a> In addition, vascular status should always be assessed because lesions that are ischemic and infected carry a risk of lower limb amputation 90 times greater than lesions without these two factors.<a class="elsevierStyleCrossRef" href="#bib4">4</a> With respect to vasculopathy, in the current study, data came from Doppler examination in 85.9% cases, in accordance with hospital-based treatment for patients with this condition (70.5%) admitted for acute foot infection, in contrast to other techniques, such as the ankle-brachial index (ABI) or transcutaneous oxygen tension (TcPO2), used in other diabetic populations.<a class="elsevierStyleCrossRefs" href="#bib12">12–14</a>In a 2-year longitudinal outcome study in 1666 consecutive diabetic patients, foot infection carried a 154.5-fold increase in the risk of amputation.<a class="elsevierStyleCrossRef" href="#bib3">3</a> The long-term prognostic determinants of foot infection identified in diabetic patients were wounds that penetrated to bone (odds ratio=6.7), wounds lasting >30 days (odds ratio=4.7), wound recurrence (odds ratio=2.4), traumatic etiology (odds ratio=2.4), and peripheral vascular disease (odds ratio=1.9).<a class="elsevierStyleCrossRef" href="#bib3">3</a> In other studies investigating factors associated with a risk of limb loss in patients with diabetic foot problems (not all of whom presented infection), neuropathy, vascular disease, ABI <0.8, gangrene, and infection were significantly associated with limb loss along the study period in the univariate analysis, but only vascular disease and infection remained in the stepwise logistic regression analysis.<a class="elsevierStyleCrossRef" href="#bib12">12</a> Thus, information on the factors predicting short-term amputation during hospital treatment of patients admitted for acute diabetic foot infections (occurring mainly in those with vascular disease) is of interest for clinicians managing the acute episode, and for this reason, this study focused on identifying these factors.Variables such as age, gender, years with diabetes, comorbidities, glycemia or insulin use, wound location, and radiography and nuclear bone scan data did not differ between patients ultimately undergoing amputation and those who did not; therefore, these factors were not predictive of short-term amputation during hospital management of acute diabetic foot infections. Nor were there differences between the groups in the microbiological data, which showed a high rate of polymicrobial cultures and S. aureus as the most frequent isolate, as has been previously reported.<a class="elsevierStyleCrossRefs" href="#bib15">15,16</a> In the bivariate analysis, white blood cell count, previous homolateral foot lesions, odor, lesion depth, sedimentation rate, Wagner classification grade, and arterial obstruction on Doppler study were significantly higher in patients ending in amputation. Nonetheless, in the multivariate analysis, the risk of amputation was only increased by Wagner's grade 4 and 5 (20-fold higher risk), obstruction (but not stenosis) seen on arterial Doppler (12.5-fold higher risk) and elevated sedimentation rate (6% risk increase per sedimentation unit). Of note, most lesions in our study population were of vasculopathic origin, and neuropathic lesions occurred in only 13.7% of non-amputated patients. This is consistent with hospital management of these lesions, since ischemia portends a poor prognosis for healing without vascular interventions.<a class="elsevierStyleCrossRef" href="#bib9">9</a> However, we found no differences between the concomitant surgical procedures performed in patients ultimately requiring amputation and those who did not.Although this is a retrospective analysis in only 78 consecutive patients, the logistic regression correctly predicted outcome in 87.2% of patients (68 out of 78) in the cohort: 92.3% of those (48 out of 52) who did not undergo amputation and 76.9% of those (20 out of 26) requiring amputation.As has been reported, amputation is a marker of diabetic foot infections as well as a marker of disease management. High amputation rates can depend on the prevalence of disease, late presentation, inadequate resources, and a particular local approach by surgeons, whereas low amputation rates may be a result of better care, perhaps provided by an experienced “foot team”<a class="elsevierStyleCrossRef" href="#bib17">17</a> or, conversely, of inappropriate conservative treatment.<a class="elsevierStyleCrossRef" href="#bib1">1</a> Regardless of these epidemiological/sociological facts, the disease presentation (clinical, imaging, and laboratory data) in patients without a previous amputation is an important clue to predict amputation during hospital management of acute diabetic foot infections on a single-hospital basis, since management of diabetic foot ulcers is based more on opinion than scientific facts.<a class="elsevierStyleCrossRef" href="#bib1">1</a> In this line, the score calculated in the present study using beta coefficients for the 3 significant variables in the regression model (Wagner grades 4 and 5, arterial obstruction on Doppler, and elevated sedimentation rate as the clinical, imaging and laboratory data, respectively) correctly predicted amputation during hospital management of acute diabetic foot infections.This study did not receive public or private financial support.The study was approved by the Ethical Review Committee of Hospital Central de la Defensa Gómez Ulla, Madrid, Spain.Conflict of interestThe authors have no conflict of interest to declare." "textoCompletoSecciones" => array:1 [ "secciones" => array:10 [ 0 => array:2 [ "identificador" => "xres150062" "titulo" => array:5 [ 0 => "Abstract" 1 => "Introduction" 2 => "Methods" 3 => "Results" 4 => "Conclusion" ] ] 1 => array:2 [ "identificador" => "xpalclavsec137996" "titulo" => "Keywords" ] 2 => array:2 [ "identificador" => "xres150063" "titulo" => array:5 [ 0 => "Resumen" 1 => "Introducción" 2 => "Métodos" 3 => "Resultados" 4 => "Conclusión" ] ] 3 => array:2 [ "identificador" => "xpalclavsec137995" "titulo" => "Palabras clave" ] 4 => array:1 [ "titulo" => "Introduction" ] 5 => array:1 [ "titulo" => "Material and methods" ] 6 => array:1 [ "titulo" => "Results" ] 7 => array:1 [ "titulo" => "Discussion" ] 8 => array:1 [ "titulo" => "Conflict of interest" ] 9 => array:1 [ "titulo" => "References" ] ] ] "pdfFichero" => "main.pdf" "tienePdf" => true "fechaRecibido" => "2009-03-16" "fechaAceptado" => "2009-12-10" "PalabrasClave" => array:2 [ "en" => array:1 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Keywords" "identificador" => "xpalclavsec137996" "palabras" => array:5 [ 0 => "Diabetes" 1 => "Foot acute infections" 2 => "Amputation" 3 => "Predictive model" 4 => "Wagner's grade" ] ] ] "es" => array:1 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Palabras clave" "identificador" => "xpalclavsec137995" "palabras" => array:5 [ 0 => "Diabetes" 1 => "Infección aguda de pie diabético" 2 => "Amputación" 3 => "Modelo de predicción" 4 => "Escala de wagner" ] ] ] ] "tieneResumen" => true "resumen" => array:2 [ "en" => array:2 [ "titulo" => "Abstract" "resumen" => "IntroductionFactors predicting short-term amputation during hospital treatment of patients admitted for acute diabetic foot infections are of interest for clinicians managing the acute episode. MethodsA retrospective clinical records analysis of 78 consecutive patients hospitalized for acute diabetic foot infections was performed to identify predictive factors for short-term amputation by comparing the data of patients who ultimately required amputation and those who did not. Clinical/epidemiological, laboratory, imaging, and treatment variables were comparatively analyzed. A logistic regression model was performed, with amputation as the dependent variable and factors showing significant differences in the bivariate analysis as independent variables. A prediction score was calculated (and validated by ROC curve analysis) using beta coefficients for significant variables in the regression analysis to predict amputation. ResultsOf the 78 patients (70.5% with peripheral vasculopathy) included, 26 ultimately required amputation. In the bivariate analysis, white blood cell count, previous homolateral lesions, odor, lesion depth, sedimentation rate, Wagner ulcer grade, and arterial obstruction on Doppler study were significantly higher in patients ending in amputation. In the multivariate analysis, the risk of amputation was increased only by Wagner grade 4 or 5 (20-fold higher), obstruction (12.5-fold higher), and elevated sedimentation rate (6% higher per unit). Logistic regression predicted outcome in 76.9% of patients who underwent amputation and 92.3% of those who did not. ConclusionThe score calculated using beta coefficients for significant variables in the regression model (Wagner grades 4 and 5, obstruction on Doppler, and elevated sedimentation rate for the clinical, imaging, and laboratory data, respectively) correctly predicted amputation during hospital management of acute diabetic foot infections." ] "es" => array:2 [ "titulo" => "Resumen" "resumen" => "IntroducciónLa identificación de factores que predigan amputación temprana durante la hospitalización de pacientes ingresados por infección aguda de pie diabético es de alto interés para el clínico que trata el episodio agudo. MétodosSe realizó un análisis retrospectivo de las historias clínicas de 78 pacientes consecutivos ingresados por infección aguda de pie diabético para identificar los factores que predicen amputación temprana mediante la comparación de los datos de los pacientes finalmente amputados con los de aquellos en los que finalmente no se realizó amputación. Se analizaron datos clínicos, epidemiológicos, analíticos, de imagen y de tratamiento. Se realizó un modelo de regresión logística utilizando como variable dependiente la amputación y como variables independientes aquellas que mostraron diferencias significativas en el análisis bivariado. Se calculó una escala de puntuaciones (validada por curvas de especificidad y sensibilidad) utilizando los coeficientes beta de las variables significativas en el modelo de regresión para predecir la amputación. ResultadosDe los 78 pacientes incluídos (70,5% con vasculopatía periférica), 26 fueron finalmente amputados. En el análisis bivariado, el recuento de leucocitos, las lesiones homolaterales previas, el olor, la extensión de la lesión, la velocidad de sedimentación, el grado en la escala de Wagner y la obstrucción arterial en el Doppler fueron significativamente mayores en los pacientes finalmente amputados. En el análisis multivariado el riesgo de amputación solo se incrementó por los grados 4–5 de la escala de Wagner (20 veces), obstrucción en el Doppler (12,5 veces) y la elevación en la velocidad de sedimentación (6% por unidad). La regresión logística predijo el resultado en el 76,9% de los casos que acabaron y en el 92,3% de los casos que no acabaron en amputación. ConclusiónEl sistema de puntuación calculado utilizando los coeficientes beta de las variables significativas en el modelo de regresión (grados 4–5 de la escala de Wagner, obstrucción en el Doppler y la elevación de la velocidad de sedimentación, como variables clínica, de imagen y analítica respectivamente) predijo correctamente la amputación durante la hospitalización por infección aguda de pie diabético." ] ] "NotaPie" => array:1 [ 0 => array:2 [ "etiqueta" => "☆" "nota" => "A part of this study was accepted for presentation at the 48th Interscience Conference on Antimicrobial Agents and Chemotherapy, Washington DC, October 2008." ] ] "multimedia" => array:4 [ 0 => array:7 [ "identificador" => "fig1" "etiqueta" => "Fig. 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 1450 "Ancho" => 1625 "Tamanyo" => 115458 ] ] "descripcion" => array:1 [ "en" => "Receiver operating characteristic (ROC) curve showing sensitivity and specificity (the oblique line represents the absence of predictive capability)." ] ] 1 => array:7 [ "identificador" => "tbl1" "etiqueta" => "Table 1" "tipo" => "MULTIMEDIATABLA" "mostrarFloat" => true "mostrarDisplay" => false "tabla" => array:2 [ "tablatextoimagen" => array:1 [ 0 => array:2 [ "tabla" => array:1 [ 0 => """ <table border="0" frame="\n \t\t\t\t\tvoid\n \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t" style="border-bottom: 2px solid black"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t" style="border-bottom: 2px solid black">Amputation n=26 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t" style="border-bottom: 2px solid black">No amputation n=52 \t\t\t\t\t\t\n \t\t\t\t</td></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Age, y (mean±SD) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t">70.5±9.6 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t">68.0±10.8 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t">% Males \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t">65.4 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t">53.8 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Years with diabetes (mean±SD) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t">14.1±10.2 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t">15.3±7.6 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t">% Patients with insulin therapy \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t">46.2 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t">51.9 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " colspan="3" align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Diabetes comorbidities (% patients)</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t">No comorbidities \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t">11.5 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Peripheral vasculopathy \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t">53.8 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t">32.7 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Cardiopathy \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t">3.8 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t">11.5 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Retinopathy \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t">3.8 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t">3.8 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Nephropathy \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t">3.8 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Previous bone lesion \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t">3.8 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t">13.5 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Several comorbidities \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t">34.6 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t">23.1 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " colspan="3" align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t"></td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " colspan="3" align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Previous foot lesions (% patients)<a class="elsevierStyleCrossRef" href="#tblfn1a">a</a></td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t">No lesions \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t">34.6 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Homolateral \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t">100 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t">1.9 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Contralateral \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t">1.9 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " colspan="3" align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t"></td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " colspan="3" align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Main cause of foot wound (% patients)</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Vasculopathy \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t">76.9 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t">68.6 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Neuropathy \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t">13.7 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Mixed \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t">23.1 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t">17.6 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t">White blood cells, ×103/mm3 (mean±SD)<a class="elsevierStyleCrossRef" href="#tblfn1a">a</a> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t">9.6±2.5 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t">7.8±2.1 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Platelets, ×103/mm3 (mean±SD) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t">266.0±84.8 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t">238.2±64.6 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Hemoglobin, mg/dL (mean±SD) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t">12.1±1.7 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t">12.1±1.7 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Creatinine, mg/dL (mean±SD) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t">1.6±0.3 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t">1.6±0.9 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Sedimentation rate, mm/h (mean±SD)<a class="elsevierStyleCrossRef" href="#tblfn1a">a</a> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t">50.1±20.1 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t">33.9±21.7 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Glycemia, mg/dL (mean±SD) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t">243.3±55.2 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t">232.0±88.1 \t\t\t\t\t\t\n \t\t\t\t</td></tr></tbody></table> """ ] "imagenFichero" => array:1 [ 0 => "xTab243899.png" ] ] ] "notaPie" => array:1 [ 0 => array:3 [ "identificador" => "tblfn1a" "etiqueta" => "a" "nota" => "P<0.01." ] ] ] "descripcion" => array:1 [ "en" => "Demographic data, previous lesions, main cause of foot wound, and baseline laboratory data of patients with diabetic foot infection undergoing amputation vs. no amputation" ] ] 2 => array:7 [ "identificador" => "tbl2" "etiqueta" => "Table 2" "tipo" => "MULTIMEDIATABLA" "mostrarFloat" => true "mostrarDisplay" => false "tabla" => array:2 [ "tablatextoimagen" => array:1 [ 0 => array:2 [ "tabla" => array:1 [ 0 => """ <table border="0" frame="\n \t\t\t\t\tvoid\n \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t" style="border-bottom: 2px solid black"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t" style="border-bottom: 2px solid black">Amputation (n=26) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t" style="border-bottom: 2px solid black">No amputation (n=52) \t\t\t\t\t\t\n \t\t\t\t</td></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " colspan="3" align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Wound location (% patients)</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Toes \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">53.8 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">53.8 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Forefoot \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">38.5 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">19.2 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Heel \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">3.8 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">19.2 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Entire foot \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">3.8 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">1.9 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Leg \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">5.8 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " colspan="3" align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t"></td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " colspan="3" align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Type of lesion (% patients)<a class="elsevierStyleCrossRef" href="#tblfn2a">a</a></td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Vascular ulcer \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">53.8 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">55.8 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Neuropathic ulcer \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">19.2 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Necrosis \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">46.2 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">19.2 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Cellulitis \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">5.8 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Lesion suppuration (% patients)<a class="elsevierStyleCrossRef" href="#tblfn2a">a</a> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">46.2 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">69.2 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Lesion odor (% patients)<a class="elsevierStyleCrossRef" href="#tblfn2a">a</a> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">76.9 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">51.9 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " colspan="3" align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t"></td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " colspan="3" align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Lesion depth (% patients)<a class="elsevierStyleCrossRef" href="#tblfn2b">b</a></td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Skin & soft tissue \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">7.7 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">48.1 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Bone \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">1.9 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Both \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">92.3 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">50.0 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " colspan="3" align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t"></td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " colspan="3" align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Wagner classification (% patients)<a class="elsevierStyleCrossRef" href="#tblfn2b">b</a></td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Grade ≤2 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">15.4 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">50.0 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Grade 3 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">7.7 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">34.6 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Grade 4 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">57.7 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">15.4 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Grade 5 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">19.2 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0.0 \t\t\t\t\t\t\n \t\t\t\t</td></tr></tbody></table> """ ] "imagenFichero" => array:1 [ 0 => "xTab243898.png" ] ] ] "notaPie" => array:2 [ 0 => array:3 [ "identificador" => "tblfn2a" "etiqueta" => "a" "nota" => "P≤0.05." ] 1 => array:3 [ "identificador" => "tblfn2b" "etiqueta" => "b" "nota" => "P≤0.01." ] ] ] "descripcion" => array:1 [ "en" => "Characteristics of lesions in patients with diabetic foot infection undergoing amputation vs. no amputation" ] ] 3 => array:7 [ "identificador" => "tbl3" "etiqueta" => "Table 3" "tipo" => "MULTIMEDIATABLA" "mostrarFloat" => true "mostrarDisplay" => false "tabla" => array:2 [ "tablatextoimagen" => array:1 [ 0 => array:2 [ "tabla" => array:1 [ 0 => """ <table border="0" frame="\n \t\t\t\t\tvoid\n \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t" style="border-bottom: 2px solid black"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t" style="border-bottom: 2px solid black">Amputation (n=26) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t" style="border-bottom: 2px solid black">Non amputation (n=52) \t\t\t\t\t\t\n \t\t\t\t</td></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " colspan="3" align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Radiography (% patients)</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t">No alterations \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">26.9 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">30.8 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Arterial calcification \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">7.7 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">11.5 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Soft tissue alterations \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">3.8 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">3.8 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Bone alterations \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">61.5 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">53.8 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " colspan="3" align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t"></td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " colspan="3" align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Doppler study: lesion location (% patients)</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Performed (n) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">26 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">41 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Femoral \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">15.4 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">4.9 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Popliteal \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">26.9 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">21.9 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Distal \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">57.7 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">73.2 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " colspan="3" align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t"></td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " colspan="3" align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Severity on arterial Doppler (% patients)<a class="elsevierStyleCrossRef" href="#tblfn3a">a</a></td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Normal \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0.0 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">21.2<a class="elsevierStyleCrossRef" href="#tblfn3b">b</a> \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Stenosis \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">15.4 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">57.7 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Obstruction \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">84.6 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">21.2 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " colspan="3" align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t"></td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " colspan="3" align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Nuclear bone scan (% patients)</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Performed (n) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t">15 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t">30 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Positive \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">86.7 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">66.7 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Negative \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">13.3 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">33.3 \t\t\t\t\t\t\n \t\t\t\t</td></tr></tbody></table> """ ] "imagenFichero" => array:1 [ 0 => "xTab243900.png" ] ] ] "notaPie" => array:2 [ 0 => array:3 [ "identificador" => "tblfn3a" "etiqueta" => "a" "nota" => "P=0.001." ] 1 => array:3 [ "identificador" => "tblfn3b" "etiqueta" => "b" "nota" => "Corresponds to 11 patients in whom Doppler was not performed because of good pedal and popliteal pulses and absence of vascular lesions." ] ] ] "descripcion" => array:1 [ "en" => "Image diagnosis and arterial Doppler in patients with diabetic foot infection undergoing amputation vs. non amputation" ] ] ] "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:1 [ "bibliografiaReferencia" => array:17 [ 0 => array:3 [ "identificador" => "bib1" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Diabetic foot ulcers" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:2 [ 0 => "W.J. Jeffcoate" 1 => "K.G. Harding" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/S0140-6736(03)13169-8" "Revista" => array:6 [ "tituloSerie" => "Lancet" "fecha" => "2003" "volumen" => "361" "paginaInicial" => "1545" "paginaFinal" => "1551" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/12737879" "web" => "Medline" ] ] ] ] ] ] ] ] 1 => array:3 [ "identificador" => "bib2" "etiqueta" => "2" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Risk factors for primary major amputation in diabetic patients" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:3 [ 0 => "V.P. Dos Santos" 1 => "D.R. da Silveira" 2 => "R.A. 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Predictive model of short-term amputation during hospitalization of patients due to acute diabetic foot infections

Modelo de predicción de amputación temprana durante la hospitalización en pacientes ingresados por infección aguda de pie diabético

J.. José Barberána,

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josebarberan@teleline.es

Corresponding author.

, J.J.. Juan-José Granizob, Lorenzo Aguilarc, Rafael Alguacild, Felipe Sainzd, Maria-Antonia Menéndeza, M.J.. Maria-José Giménezc, David Martíneze, J.. José Prietoc

a Infectious Diseases Department, Hospital Central de la Defensa Gómez Ulla, Madrid, Spain

b Granadatos, Demetrio de la Guerra 4, 28223 Pozuelo de Alarcon, Madrid, Spain

c Microbiology Department, School of Medicine, Universidad Complutense, Madrid, Spain

d Vascular Surgery Department, Hospital Central de la Defensa Gómez Ulla, Madrid, Spain

e Preventive Medicine Department, School of Medicine, Universidad Complutense, Madrid, Spain

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    "titulo" => "Predictive model of short-term amputation during hospitalization of patients due to acute diabetic foot infections"
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        "titulo" => "Modelo de predicci&#243;n de amputaci&#243;n temprana durante la hospitalizaci&#243;n en pacientes ingresados por infecci&#243;n aguda de pie diab&#233;tico"
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          "en" => "<p class="elsevierStyleSimplePara elsevierViewall">Receiver operating characteristic &#40;ROC&#41; curve showing sensitivity and specificity &#40;the oblique line represents the absence of predictive capability&#41;&#46;</p>"
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    "textoCompleto" => "<span class="elsevierStyleSections"><span class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle">Introduction</span><p class="elsevierStylePara elsevierViewall">Approximately 7&#46;5&#37; of persons with diabetes have a history of previous or active foot ulcer&#44; and the lifetime risk of experiencing this condition is up to 15&#37; in this population&#46;<a class="elsevierStyleCrossRef" href="#bib1"><span class="elsevierStyleSup">1</span></a> Factors that precipitate a skin break or impair healing can lead to foot ulceration&#44; putting the foot at risk&#46; Peripheral neuropathy implies abnormal forces applied to the foot&#44; lack of protective sensation&#44; and deficient sweating&#44; which leads to skin dryness&#46; Ischemia renders the skin less able to withstand these factors&#46; The coexistence of neuropathy&#44; ischemia &#40;the prevalence of peripheral vascular disease among diabetics is 10&#37;&#41;&#44; and leukocyte immune function disorders favors the development of severe&#44; extensive infection&#44;<a class="elsevierStyleCrossRef" href="#bib2"><span class="elsevierStyleSup">2</span></a> and infected foot wounds precede about two-thirds of amputations&#46;<a class="elsevierStyleCrossRef" href="#bib3"><span class="elsevierStyleSup">3</span></a> In this regard&#44; diabetic patients have a 10-fold greater risk of being hospitalized for bone and soft tissue infection of the foot than individuals without diabetes&#44;<a class="elsevierStyleCrossRef" href="#bib3"><span class="elsevierStyleSup">3</span></a> and those with infected ischemic lesions have a 9-fold greater chance of undergoing amputation than those without ischemia or infection&#46;<a class="elsevierStyleCrossRef" href="#bib4"><span class="elsevierStyleSup">4</span></a></p><p class="elsevierStylePara elsevierViewall">This study investigates the predictive factors for amputation during hospital treatment of acute diabetic foot infections by comparing the clinical&#44; laboratory&#44; and imaging data at admission in patients who developed criteria for amputation with those who did not&#46;</p></span><span class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle">Material and methods</span><p class="elsevierStylePara elsevierViewall">A retrospective analysis of clinical records was performed in a cohort of 78 consecutive patients with diabetes type II who had not undergone a previous amputation&#46; All patients had been admitted to the Infectious Disease Department or Vascular Surgery Department of Hospital Central de la Defensa Gomez Ulla in Madrid &#40;Spain&#41; over a 42-month period for acute diabetic foot infection&#46; A clinical evaluation including neurological and vascular status was performed daily&#44; and microbiological &#40;culture of purulent drainage&#44; curetted material&#44; or aspiration of unopened abscesses&#41;&#44; laboratory&#44; and radiographic evaluations were carried out every 1 to 2 weeks during hospitalization&#44; in keeping with the routine hospital practice&#46; Noninvasive Doppler study was performed at admission&#44; except when the patient presented good pedal and popliteal pulses and an absence of vascular lesions&#46; Patients were assigned to one of the 6 grades &#40;0&#8211;5&#41; of the Wagner ulcer classification system&#46;<a class="elsevierStyleCrossRefs" href="#bib5"><span class="elsevierStyleSup">5&#44;6</span></a> Diabetic foot ulcers were classified into 3 groups&#58; 1&#41; neuropathic lesions&#58; those present for months&#44; surrounded by callus&#44; occurring on the plantar aspect of a neuropathic foot &#40;foot warm and well perfused with palpable pulses&#44; decreased sweating&#44; and sometimes&#44; dry skin prone to fissuring&#41;&#44; 2&#41; ischemic lesions&#58; those in an ischemic foot in the absence of neuropathy&#44; and 3&#41; mixed or neuro-ischemic lesions&#58; presence of neuropathy and ischemia &#40;foot cool&#44; pulseless&#44; presenting thin&#44; shiny skin with no hair&#41;&#46;</p><p class="elsevierStylePara elsevierViewall">Infection was defined by the presence of at least 3 of the following signs or symptoms&#58; fever &#40;&#8805;38<span class="elsevierStyleHsp" style=""></span>&#176;C&#41;&#44; leukocytosis &#40;white blood cell count &#8805;10&#215;10<span class="elsevierStyleSup">3</span>&#47;mm<span class="elsevierStyleSup">3</span>&#41;&#44; local pain&#44; tenderness&#44; erythema&#44; induration and&#47;or presence of purulent secretion&#46; Osteomyelitis was diagnosed by clinical criteria &#40;bone exposure&#41;&#44; radiological criteria &#40;decrease in radiological density or cortical lyses in bone subjacent to soft tissue infection&#41;&#44; and&#47;or nuclear bone scan criteria &#40;using technetium-99<span class="elsevierStyleHsp" style=""></span>m methylene diphosphonate&#44; gallium Ga 67 citrate&#44; and indium-111-labeled white blood cells as tracers&#41;&#46; Patients who underwent amputation at admission&#44; pregnant patients&#44; and those with life-threatening diseases &#40;shock&#44; hemodynamic alterations&#41; or severe immunosuppression &#40;oncological treatments&#41; were excluded&#46;</p><p class="elsevierStylePara elsevierViewall">In accordance with the hospital treatment protocol&#44; patients were parenterally treated for at least 2 weeks with a third-generation cephalosporin plus metronidazole&#44; or a quinolone plus clindamycin&#44; or aztreonam plus clindamycin&#44; together with concomitant surgical debridement&#44; revascularization &#40;bypass&#41;&#44; sympathectomy&#44; and&#47;or reconstruction &#40;skin graft&#41; techniques&#46; Patients who developed criteria for amputation during hospital treatment for diabetic foot infection underwent this type of surgery&#46;</p><p class="elsevierStylePara elsevierViewall">For the data analysis&#44; patients were divided into 2 groups&#58; those who ultimately underwent amputation and those who did not&#46; Clinical&#47;epidemiological&#44; laboratory&#44; imaging&#44; and treatment variables were comparatively analyzed between these 2 groups&#46; The clinical&#47;epidemiological variables recorded were gender&#44; age&#44; insulin use&#44; duration of diabetes mellitus&#44; diabetes comorbidities&#44; previous foot lesions&#44; main cause of foot wound&#44; wound location&#44; type of lesion&#44; suppuration&#44; odor&#44; and lesion depth according to the Wagner classification&#46; The laboratory data included white blood cell and platelet counts&#44; hemoglobin&#44; sedimentation rate&#44; glycemia&#44; creatinine concentration&#44; and baseline microbiological culture&#46; Imaging data consisted of alterations on radiography or nuclear bone scan&#44; and lesion location and severity on arterial Doppler study &#40;patients with normal Doppler features and those in whom Doppler was not performed because of good pedal and popliteal pulses and absence of vascular lesions were considered &#8220;normal&#8221;&#41;&#46; Antimicrobial treatment and concomitant surgical techniques were also compared between groups&#46;</p><p class="elsevierStylePara elsevierViewall">Data expressed in terms of frequency were analyzed using the chi-square test&#44; and data expressed as mean&#177;standard deviation&#44; using the Student <span class="elsevierStyleItalic">t</span>-test&#44; Mann-Whitney test or Wilcoxon test&#44; when appropriate&#46; A significance level of <span class="elsevierStyleItalic">P</span>&#8804;0&#46;05 was chosen&#46;</p><p class="elsevierStylePara elsevierViewall">A logistic regression model was performed with amputation &#40;yes&#47;no&#41; as the dependent variable and factors showing significant differences in the bivariate analysis as independent variables&#46; The statistical analysis was performed with SPSS v14 &#40;SPSS Inc&#46;&#44; Chicago IL&#41;&#44; choosing the &#8220;Introduce&#8221; command for the regression model&#46; A scoring system was developed to predict amputation&#44; using beta coefficients for significant variables in the regression analysis&#46; The score was validated by receiver operating characteristic &#40;ROC&#41; curve analysis&#44; determining the sensitivity and specificity for each cut-off&#46; The greater the area of the ROC curve covering the theoretical square area&#44; the greater the predictive capability&#46;</p></span><span class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle">Results</span><p class="elsevierStylePara elsevierViewall">The demographic&#44; clinical and laboratory data at admission of patients included in this study&#44; divided into the 2 analysis groups&#44; are shown in <a class="elsevierStyleCrossRef" href="#tbl1">Table 1</a>&#46; In the overall study population&#44; mean age was 68&#46;9&#177;10&#46;4 years&#44; 57&#46;7&#37; were males&#44; mean time of diabetes evolution was 14&#46;9&#177;8&#46;5 years&#44; and 50&#46;0&#37; of patients were receiving insulin treatment&#46; There were no differences in these parameters when patients were divided into the 2 analysis groups&#46;</p><elsevierMultimedia ident="tbl1"></elsevierMultimedia><p class="elsevierStylePara elsevierViewall">The main cause of the foot wound was peripheral vasculopathy &#40;70&#46;5&#37; patients&#41;&#44; with no significant differences between the groups&#46; However&#44; a larger percentage of patients with peripheral vasculopathy &#40;53&#46;8&#37; vs&#46; 32&#46;7&#37;&#41; and comorbid conditions &#40;34&#46;6&#37; vs&#46; 23&#46;1&#37;&#41; were seen in the group ultimately requiring amputation than in the group that did not&#44; although the differences were not statistically significant&#46; A significantly higher percentage of patients had previous foot lesions &#40;homolateral lesions in all cases&#41; &#40;<span class="elsevierStyleItalic">P</span>&#61;0&#46;001&#41;&#44; higher leukocytosis &#40;<span class="elsevierStyleItalic">P</span>&#61;0&#46;001&#41;&#44; and higher sedimentation rate &#40;<span class="elsevierStyleItalic">P</span>&#61;0&#46;002&#41; in the group ultimately undergoing amputation&#46;</p><p class="elsevierStylePara elsevierViewall">The characteristics of the lesions at admission are shown in <a class="elsevierStyleCrossRef" href="#tbl2">Table 2</a>&#46; The most frequent wound location in both groups was the toes &#40;53&#46;8&#37;&#41;&#46; A significantly larger percentage of patients presenting necrosis &#40;myonecrosis &#91;gangrene&#93; and&#47;or necrotizing fasciitis&#41;&#44; odor&#44; and involvement of skin and soft tissue plus bone was found in the group requiring amputation&#44; whereas a higher percentage of patients with suppuration and exclusive involvement of either bone or skin and soft tissue was found in the group that did not require amputation&#46; Distribution of patients by Wagner ulcer classification showed grades 4 and 5 in 76&#46;9&#37; patients who underwent amputation and grade &#8804;3 in 84&#46;6&#37; of those who did not &#40;<span class="elsevierStyleItalic">P</span>&#60;0&#46;001&#41;&#46;</p><elsevierMultimedia ident="tbl2"></elsevierMultimedia><p class="elsevierStylePara elsevierViewall">Samples for microbiological culture were taken in 56 patients&#44; and 50 of them &#40;89&#46;2&#37;&#41; yielded bacterial growth&#46; The infection was monomicrobial in 38&#37; of cases &#40;19 of 50&#41;&#44; and polymicrobial in 62&#37; of cases &#40;31 of 50&#41;&#46; <span class="elsevierStyleItalic">Staphylococcus aureus</span> was the most frequently isolated microorganism &#40;40&#37; of samples&#41;&#44; followed by <span class="elsevierStyleItalic">Staphylococcus epidermidis</span> &#40;19&#37;&#41;&#44; <span class="elsevierStyleItalic">Klebsiella spp</span> &#40;8&#37;&#41;&#44; <span class="elsevierStyleItalic">Pseudomonas aeruginosa</span> &#40;8&#37;&#41;&#44; <span class="elsevierStyleItalic">Escherichia coli</span> &#40;6&#37;&#41;&#44; <span class="elsevierStyleItalic">Enterococcus spp&#46;</span> &#40;6&#37;&#41; and anaerobes &#40;6&#37;&#41;&#46;</p><p class="elsevierStylePara elsevierViewall">Data on the imaging diagnosis and arterial Doppler at admission are shown in <a class="elsevierStyleCrossRef" href="#tbl3">table 3</a>&#46; In the overall population&#44; radiographs disclosed bone alterations in 56&#46;4&#37; patients and no alterations in 29&#46;5&#37;&#44; with no differences when patients were divided into the 2 study groups&#46; Nuclear bone scan was performed in 45 patients and 73&#46;3&#37; were positive&#44; with no significant differences between the groups&#46; Doppler study was carried out in 67 &#40;85&#46;9&#37;&#41; patients&#58; 84&#46;6&#37; of those in the amputated group presented arterial obstruction&#44; whereas stenosis was more frequent &#40;57&#46;7&#37;&#41; in the group without amputation &#40;<span class="elsevierStyleItalic">P</span>&#60;0&#46;001&#41;&#46;</p><elsevierMultimedia ident="tbl3"></elsevierMultimedia><p class="elsevierStylePara elsevierViewall">No between-group differences were found with respect to antibiotic treatment&#58; 20&#37;&#44; 40&#37;&#44; and 40&#37; patients ending in amputation&#44; and 23&#37;&#44; 50&#37;&#44; and 27&#37; patients who did not&#44; received third-generation cephalosporin plus metronidazole&#44; aztreonam plus clindamycin&#44; and quinolone plus clindamycin&#44; respectively&#46; Mean duration of treatment was 29&#46;2&#177;7&#46;4 days&#44; with no differences between the groups&#46; With respect to concomitant surgical procedures&#44; debridement&#44; sympathectomy&#44; bypass&#44; and skin graft were performed in 88&#46;5&#37;&#44; 3&#46;8&#37;&#44; 3&#46;8&#37;&#44; and 3&#46;8&#37; of patients ending in amputation and 90&#46;4&#37;&#44; 1&#46;9&#37;&#44; 3&#46;8&#37;&#44; and 3&#46;8&#37; of the other patients&#44; respectively&#46; Mean time to amputation was 18&#46;0&#177;6&#46;6 days&#46;</p><p class="elsevierStylePara elsevierViewall">In the multivariate analysis&#44; Wagner classification grades 4 and 5 showed a higher odds ratio &#40;20&#46;00&#44; 95&#37; CI 3&#46;62&#8211;111&#46;11&#59; <span class="elsevierStyleItalic">P</span>&#61;0&#46;001&#41; than reference grades 0&#8211;3&#44; which was followed by arterial obstruction on Doppler &#40;odds ratio&#61;12&#46;50&#59; 95&#37; CI&#61;1&#46;42&#8211;66&#46;67&#59; <span class="elsevierStyleItalic">P</span>&#61;0&#46;003&#41;&#44; and the sedimentation rate &#40;odds ratio&#61;1&#46;06&#59; 95&#37; CI&#61;1&#46;01&#8211;1&#46;10&#59; <span class="elsevierStyleItalic">P</span>&#61;0&#46;013&#41;&#46; These 3 variables explained the best goodness of the fit &#40;r<span class="elsevierStyleSup">2</span> Cox&#61;0&#46;522&#59; <span class="elsevierStyleItalic">P</span>&#60;0&#46;001&#41;&#46;</p><p class="elsevierStylePara elsevierViewall">Using exponentiation of the beta coefficients for significant variables &#40;Doppler severity&#44; DS &#91;obstruction&#61;3&#44; stenosis&#47;normal&#61;1&#93;&#44; Wagner grade&#44; WG &#91;grades 4 and 5&#61;5&#59; grades 0&#8211;3&#61;1&#93;&#44; and sedimentation rate&#44; SR &#91;100&#47;crude sedimentation rate&#93;&#41; in the regression analysis&#44; the predictive score was constructed as SCORE&#61;DS&#43;WG&#43;SR&#46; The score range was 2&#46;01&#8211;8&#46;78&#44; and the area under curve in the ROC analysis was 0&#46;93 &#40;<span class="elsevierStyleItalic">P</span>&#60;0&#46;001&#41; &#40;<a class="elsevierStyleCrossRef" href="#fig1">Fig&#46; 1</a>&#41;&#46;</p><elsevierMultimedia ident="fig1"></elsevierMultimedia><p class="elsevierStylePara elsevierViewall">A cut-off &#8804;2&#46;31 showed 100&#37; specificity and 37&#46;5&#37; sensitivity for no amputation&#44; and a cut-off &#8805;8&#46;38 showed 100&#37; specificity and 46&#46;2&#37; sensitivity for amputation&#46; The highest predictive value for amputation was obtained with a predictive score cut-off of 4&#46;375 &#40;sensitivity&#61;96&#46;2&#37;&#59; specificity&#61;78&#46;8&#37;&#41;&#46;</p></span><span class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle">Discussion</span><p class="elsevierStylePara elsevierViewall">Infection is rarely implicated in the etiology of diabetic foot ulcers&#44; but ulcers are susceptible to infection and for most of these patients&#44; infection is a pivotal event that leads to limb complications&#44; including amputation&#46; Wound infections must be diagnosed clinically&#44;<a class="elsevierStyleCrossRef" href="#bib7"><span class="elsevierStyleSup">7</span></a> and many risk factors for foot ulcers are also predisposing factors for amputation&#44;<a class="elsevierStyleCrossRefs" href="#bib8"><span class="elsevierStyleSup">8&#44;9</span></a> at a site where culture of wound material is usually not recommended<a class="elsevierStyleCrossRef" href="#bib10"><span class="elsevierStyleSup">10</span></a> and radiography is not a highly sensitive indicator of acute bone infection&#46;<a class="elsevierStyleCrossRef" href="#bib11"><span class="elsevierStyleSup">11</span></a> In addition&#44; vascular status should always be assessed because lesions that are ischemic and infected carry a risk of lower limb amputation 90 times greater than lesions without these two factors&#46;<a class="elsevierStyleCrossRef" href="#bib4"><span class="elsevierStyleSup">4</span></a> With respect to vasculopathy&#44; in the current study&#44; data came from Doppler examination in 85&#46;9&#37; cases&#44; in accordance with hospital-based treatment for patients with this condition &#40;70&#46;5&#37;&#41; admitted for acute foot infection&#44; in contrast to other techniques&#44; such as the ankle-brachial index &#40;ABI&#41; or transcutaneous oxygen tension &#40;TcPO<span class="elsevierStyleInf">2</span>&#41;&#44; used in other diabetic populations&#46;<a class="elsevierStyleCrossRefs" href="#bib12"><span class="elsevierStyleSup">12&#8211;14</span></a></p><p class="elsevierStylePara elsevierViewall">In a 2-year longitudinal outcome study in 1666 consecutive diabetic patients&#44; foot infection carried a 154&#46;5-fold increase in the risk of amputation&#46;<a class="elsevierStyleCrossRef" href="#bib3"><span class="elsevierStyleSup">3</span></a> The long-term prognostic determinants of foot infection identified in diabetic patients were wounds that penetrated to bone &#40;odds ratio&#61;6&#46;7&#41;&#44; wounds lasting &#62;30 days &#40;odds ratio&#61;4&#46;7&#41;&#44; wound recurrence &#40;odds ratio&#61;2&#46;4&#41;&#44; traumatic etiology &#40;odds ratio&#61;2&#46;4&#41;&#44; and peripheral vascular disease &#40;odds ratio&#61;1&#46;9&#41;&#46;<a class="elsevierStyleCrossRef" href="#bib3"><span class="elsevierStyleSup">3</span></a> In other studies investigating factors associated with a risk of limb loss in patients with diabetic foot problems &#40;not all of whom presented infection&#41;&#44; neuropathy&#44; vascular disease&#44; ABI &#60;0&#46;8&#44; gangrene&#44; and infection were significantly associated with limb loss along the study period in the univariate analysis&#44; but only vascular disease and infection remained in the stepwise logistic regression analysis&#46;<a class="elsevierStyleCrossRef" href="#bib12"><span class="elsevierStyleSup">12</span></a> Thus&#44; information on the factors predicting short-term amputation during hospital treatment of patients admitted for acute diabetic foot infections &#40;occurring mainly in those with vascular disease&#41; is of interest for clinicians managing the acute episode&#44; and for this reason&#44; this study focused on identifying these factors&#46;</p><p class="elsevierStylePara elsevierViewall">Variables such as age&#44; gender&#44; years with diabetes&#44; comorbidities&#44; glycemia or insulin use&#44; wound location&#44; and radiography and nuclear bone scan data did not differ between patients ultimately undergoing amputation and those who did not&#59; therefore&#44; these factors were not predictive of short-term amputation during hospital management of acute diabetic foot infections&#46; Nor were there differences between the groups in the microbiological data&#44; which showed a high rate of polymicrobial cultures and <span class="elsevierStyleItalic">S&#46; aureus</span> as the most frequent isolate&#44; as has been previously reported&#46;<a class="elsevierStyleCrossRefs" href="#bib15"><span class="elsevierStyleSup">15&#44;16</span></a> In the bivariate analysis&#44; white blood cell count&#44; previous homolateral foot lesions&#44; odor&#44; lesion depth&#44; sedimentation rate&#44; Wagner classification grade&#44; and arterial obstruction on Doppler study were significantly higher in patients ending in amputation&#46; Nonetheless&#44; in the multivariate analysis&#44; the risk of amputation was only increased by Wagner&#39;s grade 4 and 5 &#40;20-fold higher risk&#41;&#44; obstruction &#40;but not stenosis&#41; seen on arterial Doppler &#40;12&#46;5-fold higher risk&#41; and elevated sedimentation rate &#40;6&#37; risk increase per sedimentation unit&#41;&#46; Of note&#44; most lesions in our study population were of vasculopathic origin&#44; and neuropathic lesions occurred in only 13&#46;7&#37; of non-amputated patients&#46; This is consistent with hospital management of these lesions&#44; since ischemia portends a poor prognosis for healing without vascular interventions&#46;<a class="elsevierStyleCrossRef" href="#bib9"><span class="elsevierStyleSup">9</span></a> However&#44; we found no differences between the concomitant surgical procedures performed in patients ultimately requiring amputation and those who did not&#46;</p><p class="elsevierStylePara elsevierViewall">Although this is a retrospective analysis in only 78 consecutive patients&#44; the logistic regression correctly predicted outcome in 87&#46;2&#37; of patients &#40;68 out of 78&#41; in the cohort&#58; 92&#46;3&#37; of those &#40;48 out of 52&#41; who did not undergo amputation and 76&#46;9&#37; of those &#40;20 out of 26&#41; requiring amputation&#46;</p><p class="elsevierStylePara elsevierViewall">As has been reported&#44; amputation is a marker of diabetic foot infections as well as a marker of disease management&#46; High amputation rates can depend on the prevalence of disease&#44; late presentation&#44; inadequate resources&#44; and a particular local approach by surgeons&#44; whereas low amputation rates may be a result of better care&#44; perhaps provided by an experienced &#8220;foot team&#8221;<a class="elsevierStyleCrossRef" href="#bib17"><span class="elsevierStyleSup">17</span></a> or&#44; conversely&#44; of inappropriate conservative treatment&#46;<a class="elsevierStyleCrossRef" href="#bib1"><span class="elsevierStyleSup">1</span></a> Regardless of these epidemiological&#47;sociological facts&#44; the disease presentation &#40;clinical&#44; imaging&#44; and laboratory data&#41; in patients without a previous amputation is an important clue to predict amputation during hospital management of acute diabetic foot infections on a single-hospital basis&#44; since management of diabetic foot ulcers is based more on opinion than scientific facts&#46;<a class="elsevierStyleCrossRef" href="#bib1"><span class="elsevierStyleSup">1</span></a> In this line&#44; the score calculated in the present study using beta coefficients for the 3 significant variables in the regression model &#40;Wagner grades 4 and 5&#44; arterial obstruction on Doppler&#44; and elevated sedimentation rate as the clinical&#44; imaging and laboratory data&#44; respectively&#41; correctly predicted amputation during hospital management of acute diabetic foot infections&#46;</p><p class="elsevierStylePara elsevierViewall">This study did not receive public or private financial support&#46;</p><p class="elsevierStylePara elsevierViewall">The study was approved by the Ethical Review Committee of Hospital Central de la Defensa G&#243;mez Ulla&#44; Madrid&#44; Spain&#46;</p></span><span class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle">Conflict of interest</span><p class="elsevierStylePara elsevierViewall">The authors have no conflict of interest to declare&#46;</p></span></span>"
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          "titulo" => array:5 [
            0 => "Resumen"
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          "titulo" => "Discussion"
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        8 => array:1 [
          "titulo" => "Conflict of interest"
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    "pdfFichero" => "main.pdf"
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    "fechaRecibido" => "2009-03-16"
    "fechaAceptado" => "2009-12-10"
    "PalabrasClave" => array:2 [
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        0 => array:4 [
          "clase" => "keyword"
          "titulo" => "Keywords"
          "identificador" => "xpalclavsec137996"
          "palabras" => array:5 [
            0 => "Diabetes"
            1 => "Foot acute infections"
            2 => "Amputation"
            3 => "Predictive model"
            4 => "Wagner&#39;s grade"
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        0 => array:4 [
          "clase" => "keyword"
          "titulo" => "Palabras clave"
          "identificador" => "xpalclavsec137995"
          "palabras" => array:5 [
            0 => "Diabetes"
            1 => "Infecci&#243;n aguda de pie diab&#233;tico"
            2 => "Amputaci&#243;n"
            3 => "Modelo de predicci&#243;n"
            4 => "Escala de wagner"
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        "titulo" => "Abstract"
        "resumen" => "<span class="elsevierStyleSectionTitle">Introduction</span><p class="elsevierStyleSimplePara elsevierViewall">Factors predicting short-term amputation during hospital treatment of patients admitted for acute diabetic foot infections are of interest for clinicians managing the acute episode&#46;</p> <span class="elsevierStyleSectionTitle">Methods</span><p class="elsevierStyleSimplePara elsevierViewall">A retrospective clinical records analysis of 78 consecutive patients hospitalized for acute diabetic foot infections was performed to identify predictive factors for short-term amputation by comparing the data of patients who ultimately required amputation and those who did not&#46; Clinical&#47;epidemiological&#44; laboratory&#44; imaging&#44; and treatment variables were comparatively analyzed&#46; A logistic regression model was performed&#44; with amputation as the dependent variable and factors showing significant differences in the bivariate analysis as independent variables&#46; A prediction score was calculated &#40;and validated by ROC curve analysis&#41; using beta coefficients for significant variables in the regression analysis to predict amputation&#46;</p> <span class="elsevierStyleSectionTitle">Results</span><p class="elsevierStyleSimplePara elsevierViewall">Of the 78 patients &#40;70&#46;5&#37; with peripheral vasculopathy&#41; included&#44; 26 ultimately required amputation&#46; In the bivariate analysis&#44; white blood cell count&#44; previous homolateral lesions&#44; odor&#44; lesion depth&#44; sedimentation rate&#44; Wagner ulcer grade&#44; and arterial obstruction on Doppler study were significantly higher in patients ending in amputation&#46; In the multivariate analysis&#44; the risk of amputation was increased only by Wagner grade 4 or 5 &#40;20-fold higher&#41;&#44; obstruction &#40;12&#46;5-fold higher&#41;&#44; and elevated sedimentation rate &#40;6&#37; higher per unit&#41;&#46; Logistic regression predicted outcome in 76&#46;9&#37; of patients who underwent amputation and 92&#46;3&#37; of those who did not&#46;</p> <span class="elsevierStyleSectionTitle">Conclusion</span><p class="elsevierStyleSimplePara elsevierViewall">The score calculated using beta coefficients for significant variables in the regression model &#40;Wagner grades 4 and 5&#44; obstruction on Doppler&#44; and elevated sedimentation rate for the clinical&#44; imaging&#44; and laboratory data&#44; respectively&#41; correctly predicted amputation during hospital management of acute diabetic foot infections&#46;</p>"
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      "es" => array:2 [
        "titulo" => "Resumen"
        "resumen" => "<span class="elsevierStyleSectionTitle">Introducci&#243;n</span><p class="elsevierStyleSimplePara elsevierViewall">La identificaci&#243;n de factores que predigan amputaci&#243;n temprana durante la hospitalizaci&#243;n de pacientes ingresados por infecci&#243;n aguda de pie diab&#233;tico es de alto inter&#233;s para el cl&#237;nico que trata el episodio agudo&#46;</p> <span class="elsevierStyleSectionTitle">M&#233;todos</span><p class="elsevierStyleSimplePara elsevierViewall">Se realiz&#243; un an&#225;lisis retrospectivo de las historias cl&#237;nicas de 78 pacientes consecutivos ingresados por infecci&#243;n aguda de pie diab&#233;tico para identificar los factores que predicen amputaci&#243;n temprana mediante la comparaci&#243;n de los datos de los pacientes finalmente amputados con los de aquellos en los que finalmente no se realiz&#243; amputaci&#243;n&#46; Se analizaron datos cl&#237;nicos&#44; epidemiol&#243;gicos&#44; anal&#237;ticos&#44; de imagen y de tratamiento&#46; Se realiz&#243; un modelo de regresi&#243;n log&#237;stica utilizando como variable dependiente la amputaci&#243;n y como variables independientes aquellas que mostraron diferencias significativas en el an&#225;lisis bivariado&#46; Se calcul&#243; una escala de puntuaciones &#40;validada por curvas de especificidad y sensibilidad&#41; utilizando los coeficientes beta de las variables significativas en el modelo de regresi&#243;n para predecir la amputaci&#243;n&#46;</p> <span class="elsevierStyleSectionTitle">Resultados</span><p class="elsevierStyleSimplePara elsevierViewall">De los 78 pacientes inclu&#237;dos &#40;70&#44;5&#37; con vasculopat&#237;a perif&#233;rica&#41;&#44; 26 fueron finalmente amputados&#46; En el an&#225;lisis bivariado&#44; el recuento de leucocitos&#44; las lesiones homolaterales previas&#44; el olor&#44; la extensi&#243;n de la lesi&#243;n&#44; la velocidad de sedimentaci&#243;n&#44; el grado en la escala de Wagner y la obstrucci&#243;n arterial en el Doppler fueron significativamente mayores en los pacientes finalmente amputados&#46; En el an&#225;lisis multivariado el riesgo de amputaci&#243;n solo se increment&#243; por los grados 4&#8211;5 de la escala de Wagner &#40;20 veces&#41;&#44; obstrucci&#243;n en el Doppler &#40;12&#44;5 veces&#41; y la elevaci&#243;n en la velocidad de sedimentaci&#243;n &#40;6&#37; por unidad&#41;&#46; La regresi&#243;n log&#237;stica predijo el resultado en el 76&#44;9&#37; de los casos que acabaron y en el 92&#44;3&#37; de los casos que no acabaron en amputaci&#243;n&#46;</p> <span class="elsevierStyleSectionTitle">Conclusi&#243;n</span><p class="elsevierStyleSimplePara elsevierViewall">El sistema de puntuaci&#243;n calculado utilizando los coeficientes beta de las variables significativas en el modelo de regresi&#243;n &#40;grados 4&#8211;5 de la escala de Wagner&#44; obstrucci&#243;n en el Doppler y la elevaci&#243;n de la velocidad de sedimentaci&#243;n&#44; como variables cl&#237;nica&#44; de imagen y anal&#237;tica respectivamente&#41; predijo correctamente la amputaci&#243;n durante la hospitalizaci&#243;n por infecci&#243;n aguda de pie diab&#233;tico&#46;</p>"
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        "nota" => "<p class="elsevierStyleNotepara">A part of this study was accepted for presentation at the 48th Interscience Conference on Antimicrobial Agents and Chemotherapy&#44; Washington DC&#44; October 2008&#46;</p>"
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          "en" => "<p class="elsevierStyleSimplePara elsevierViewall">Receiver operating characteristic &#40;ROC&#41; curve showing sensitivity and specificity &#40;the oblique line represents the absence of predictive capability&#41;&#46;</p>"
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                  <table border="0" frame="\n
                  \t\t\t\t\tvoid\n
                  \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" style="border-bottom: 2px solid black">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-head\n
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                  \t\t\t\t" style="border-bottom: 2px solid black"><span class="elsevierStyleBold">Amputation n&#61;26</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t" style="border-bottom: 2px solid black"><span class="elsevierStyleBold">No amputation n&#61;52</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleBold">Age&#44; y &#40;mean&#177;SD&#41;</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">70&#46;5&#177;9&#46;6&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">68&#46;0&#177;10&#46;8&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleBold">&#37; Males</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">65&#46;4&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">53&#46;8&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleBold">Years with diabetes &#40;mean&#177;SD&#41;</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">14&#46;1&#177;10&#46;2&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">15&#46;3&#177;7&#46;6&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleBold">&#37; Patients with insulin therapy</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">46&#46;2&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">51&#46;9&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " colspan="3" align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleBold">Diabetes comorbidities &#40;&#37; patients&#41;</span></td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>No comorbidities&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">11&#46;5&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Peripheral vasculopathy&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">53&#46;8&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">32&#46;7&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
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                  \t\t\t\t  " align="" valign="\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Cardiopathy&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
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                  \t\t\t\t">3&#46;8&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">11&#46;5&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Retinopathy&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">3&#46;8&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">3&#46;8&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Nephropathy&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="" valign="\n
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                  \t\t\t\t">0&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">3&#46;8&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Previous bone lesion&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">3&#46;8&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">13&#46;5&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Several comorbidities&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">34&#46;6&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">23&#46;1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " colspan="3" align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " colspan="3" align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleBold">Previous foot lesions &#40;&#37; patients&#41;</span><a class="elsevierStyleCrossRef" href="#tblfn1a"><span class="elsevierStyleSup">a</span></a></td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>No lesions&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">34&#46;6&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Homolateral&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">100&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">1&#46;9&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Contralateral&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">1&#46;9&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " colspan="3" align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " colspan="3" align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleBold">Main cause of foot wound &#40;&#37; patients&#41;</span></td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Vasculopathy&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">76&#46;9&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">68&#46;6&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Neuropathy&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">13&#46;7&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Mixed&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">23&#46;1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">17&#46;6&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleBold">White blood cells&#44; &#215;10<span class="elsevierStyleSup">3</span>&#47;mm<span class="elsevierStyleSup">3</span> &#40;mean&#177;SD&#41;</span><a class="elsevierStyleCrossRef" href="#tblfn1a"><span class="elsevierStyleSup">a</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">9&#46;6&#177;2&#46;5&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">7&#46;8&#177;2&#46;1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleBold">Platelets&#44; &#215;10<span class="elsevierStyleSup">3</span>&#47;mm<span class="elsevierStyleSup">3</span> &#40;mean&#177;SD&#41;</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">266&#46;0&#177;84&#46;8&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">238&#46;2&#177;64&#46;6&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleBold">Hemoglobin&#44; mg&#47;dL &#40;mean&#177;SD&#41;</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">12&#46;1&#177;1&#46;7&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">12&#46;1&#177;1&#46;7&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleBold">Creatinine&#44; mg&#47;dL &#40;mean&#177;SD&#41;</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">1&#46;6&#177;0&#46;3&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">1&#46;6&#177;0&#46;9&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleBold">Sedimentation rate&#44; mm&#47;h &#40;mean&#177;SD&#41;</span><a class="elsevierStyleCrossRef" href="#tblfn1a"><span class="elsevierStyleSup">a</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">50&#46;1&#177;20&#46;1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">33&#46;9&#177;21&#46;7&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleBold">Glycemia&#44; mg&#47;dL &#40;mean&#177;SD&#41;</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">243&#46;3&#177;55&#46;2&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">232&#46;0&#177;88&#46;1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></tbody></table>
                  """
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                  \t\t\t\t\tvoid\n
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                  \t\t\t\t" style="border-bottom: 2px solid black">&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttop\n
                  \t\t\t\t" style="border-bottom: 2px solid black"><span class="elsevierStyleBold">Amputation &#40;n&#61;26&#41;</span>&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttop\n
                  \t\t\t\t" style="border-bottom: 2px solid black"><span class="elsevierStyleBold">No amputation &#40;n&#61;52&#41;</span>&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
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                  \t\t\t\t"><span class="elsevierStyleBold">Wound location &#40;&#37; patients&#41;</span></td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">53&#46;8&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
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                  \t\t\t\t">53&#46;8&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Forefoot&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">38&#46;5&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
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                  \t\t\t\t">19&#46;2&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Heel&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="char" valign="\n
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                  \t\t\t\t">3&#46;8&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">19&#46;2&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Entire foot&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">3&#46;8&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">1&#46;9&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Leg&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
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                  \t\t\t\t">5&#46;8&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " colspan="3" align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " colspan="3" align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleBold">Type of lesion &#40;&#37; patients&#41;</span><a class="elsevierStyleCrossRef" href="#tblfn2a"><span class="elsevierStyleSup">a</span></a></td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Vascular ulcer&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">53&#46;8&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">55&#46;8&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Neuropathic ulcer&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">19&#46;2&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Necrosis&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">46&#46;2&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">19&#46;2&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
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                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Cellulitis&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">5&#46;8&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleBold">Lesion suppuration &#40;&#37; patients&#41;</span><a class="elsevierStyleCrossRef" href="#tblfn2a"><span class="elsevierStyleSup">a</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">46&#46;2&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">69&#46;2&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleBold">Lesion odor &#40;&#37; patients&#41;</span><a class="elsevierStyleCrossRef" href="#tblfn2a"><span class="elsevierStyleSup">a</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">76&#46;9&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">51&#46;9&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " colspan="3" align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " colspan="3" align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleBold">Lesion depth &#40;&#37; patients&#41;</span><a class="elsevierStyleCrossRef" href="#tblfn2b"><span class="elsevierStyleSup">b</span></a></td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Skin &#38; soft tissue&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">7&#46;7&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">48&#46;1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Bone&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">1&#46;9&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">92&#46;3&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">50&#46;0&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " colspan="3" align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " colspan="3" align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleBold">Wagner classification &#40;&#37; patients&#41;</span><a class="elsevierStyleCrossRef" href="#tblfn2b"><span class="elsevierStyleSup">b</span></a></td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Grade &#8804;2&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">15&#46;4&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">50&#46;0&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Grade 3&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">7&#46;7&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">34&#46;6&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Grade 4&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">57&#46;7&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">15&#46;4&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Grade 5&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">19&#46;2&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#46;0&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\tvoid\n
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                  \t\t\t\t" style="border-bottom: 2px solid black">&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t" style="border-bottom: 2px solid black"><span class="elsevierStyleBold">Amputation &#40;n&#61;26&#41;</span>&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>No alterations&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">26&#46;9&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">30&#46;8&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Arterial calcification&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">7&#46;7&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">11&#46;5&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Soft tissue alterations&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">3&#46;8&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
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                  \t\t\t\t">3&#46;8&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Bone alterations&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">61&#46;5&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">53&#46;8&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " colspan="3" align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " colspan="3" align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleBold">Doppler study&#58; lesion location &#40;&#37; patients&#41;</span></td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Performed &#40;n&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">26&nbsp;\t\t\t\t\t\t\n
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                            1 => "B&#46; Wyssa"
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Article information

ISSN: 0213005X
Original language: English

DOI:10.1016/j.eimc.2009.12.017

The statistics are updated each day

Year/Month	Html	Pdf	Total

2024 November	2	1	3
2024 October	19	6	25
2024 September	22	10	32
2024 August	20	9	29
2024 July	26	5	31
2024 June	15	3	18
2024 May	16	9	25
2024 April	29	6	35
2024 March	23	5	28
2024 February	17	3	20
2024 January	30	2	32
2023 December	20	3	23
2023 November	19	4	23
2023 October	55	12	67
2023 September	10	4	14
2023 August	18	2	20
2023 July	25	9	34
2023 June	35	6	41
2023 May	29	9	38
2023 April	29	5	34
2023 March	21	4	25
2023 February	21	8	29
2023 January	13	13	26
2022 December	15	13	28
2022 November	36	13	49
2022 October	16	9	25
2022 September	19	12	31
2022 August	26	19	45
2022 July	20	8	28
2022 June	12	12	24
2022 May	17	12	29
2022 April	9	15	24
2022 March	24	17	41
2022 February	30	8	38
2022 January	52	14	66
2021 December	14	15	29
2021 November	14	7	21
2021 October	20	16	36
2021 September	17	7	24
2021 August	20	8	28
2021 July	30	12	42
2021 June	32	10	42
2021 May	36	7	43
2021 April	36	15	51
2021 March	64	10	74
2021 February	27	10	37
2021 January	21	17	38
2020 December	10	6	16
2020 November	12	10	22
2020 October	18	6	24
2020 September	19	9	28
2020 August	19	12	31
2020 July	14	18	32
2020 June	13	11	24
2020 May	36	3	39
2020 April	19	8	27
2020 March	26	9	35
2020 February	28	7	35
2020 January	40	10	50
2019 December	20	12	32
2019 November	21	11	32
2019 October	11	8	19
2019 September	18	2	20
2019 August	21	8	29
2019 July	16	5	21
2019 June	47	19	66
2019 May	135	35	170
2019 April	54	18	72
2019 March	11	8	19
2019 February	18	11	29
2019 January	9	4	13
2018 December	17	2	19
2018 November	25	5	30
2018 October	19	10	29
2018 September	29	10	39
2018 August	16	2	18
2018 July	17	2	19
2018 June	12	0	12
2018 May	8	4	12
2018 April	37	0	37
2018 March	60	0	60
2018 February	11	0	11
2018 January	70	1	71
2017 December	34	0	34
2017 November	11	0	11
2017 October	10	2	12
2017 September	27	6	33
2017 August	20	2	22
2017 July	8	3	11
2017 June	11	5	16
2017 May	18	10	28
2017 April	8	7	15
2017 March	12	16	28
2017 February	11	4	15
2017 January	12	0	12
2016 December	13	2	15
2016 November	14	3	17
2016 October	65	1	66
2016 September	30	7	37
2016 August	46	4	50
2016 July	24	0	24
2016 June	38	5	43
2016 May	25	1	26
2016 April	20	20	40
2016 March	26	5	31
2016 February	14	5	19
2016 January	24	7	31
2015 December	20	10	30
2015 November	25	4	29
2015 October	22	4	26
2015 September	26	4	30
2015 August	32	10	42
2015 July	14	2	16
2015 June	11	3	14
2015 May	15	2	17
2015 April	42	11	53
2015 March	24	3	27
2015 February	30	3	33
2015 January	26	2	28
2014 December	32	5	37
2014 November	25	1	26
2014 October	44	4	48
2014 September	32	3	35
2014 August	28	1	29
2014 July	29	1	30
2014 June	32	1	33
2014 May	17	0	17
2014 April	29	2	31
2014 March	60	4	64
2014 February	48	9	57
2014 January	46	6	52
2013 December	62	8	70
2013 November	64	6	70
2013 October	73	10	83
2013 September	57	8	65
2013 August	69	11	80
2013 July	68	3	71
2013 June	17	4	21
2013 May	23	7	30
2013 April	30	6	36
2013 March	17	6	23
2013 February	8	5	13
2013 January	6	5	11
2012 December	7	1	8
2012 November	2	4	6
2012 October	2	1	3
2010 December	1589	0	1589

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