Skip to main content
main-content

01.12.2017 | Original investigation | Ausgabe 1/2017 Open Access

Cardiovascular Diabetology 1/2017

Impact of diabetes on outcome in critical limb ischemia with tissue loss: a large-scaled routine data analysis

Zeitschrift:
Cardiovascular Diabetology > Ausgabe 1/2017
Autoren:
Eva Freisinger, Nasser M. Malyar, Holger Reinecke, Holger Lawall
Wichtige Hinweise

Electronic supplementary material

The online version of this article (doi:10.​1186/​s12933-017-0524-8) contains supplementary material, which is available to authorized users.

Abstract

Background

Patients with diabetes concomitant to critical limb ischemia (CLI) represent a sub-group at particular risk. Objective of this analysis is to evaluate the actual impact of diabetes on treatment, outcome, and costs in a real-world scenario in Germany.

Methods

We obtained routine-data on 15,332 patients with CLI with tissue loss from the largest German health insurance, BARMER GEK from 2009 to 2011, including a follow-up until 2013. Patient data were analyzed regarding co-diagnosis with diabetes with respect to risk profiles, treatment strategy, in-hospital and long-term outcome including costs.

Results

Diabetic patients received less overall revascularizations in Rutherford grades 5 and 6 (Rutherford grade 5: 45.0 vs. 55.5%; Rutherford grade 6: 46.5 vs. 51.8; p < 0.001) and less vascular surgery (Rutherford grade 5: 13.4 vs. 23.4; Rutherford grade 6: 19.7 vs. 29.6; p < 0.001), however more often endovascular revascularization in Rutherford grade 6 (31.0 vs. 28.1; p = 0.004) compared to non-diabetic patients. Diabetes was associated with a higher observed ratio of infections (35.3 vs. 23.5% Rutherford grade 5; 44.3 vs. 27.4% Rutherford grade 6; p < 0.001) and in-hospital amputations (13.0 vs. 7.3% Rutherford grade 5; 47.5 vs. 36.7% Ruth6; p < 0.001). Diabetes further increased the risk for amputation during follow-up [Rutherford grade 5: HR 1.51 (1.38–1.67); Rutherford grade 6: HR 1.33 (1.25–1.41); p < 0.001], but not for death.

Conclusions

Diabetes increases markedly the risk of amputation attended by higher costs in CLI patients with tissue loss (OR 1.67 at Rutherford 5, OR 1.53 at Rutherford 6; p < 0.001), but is associated with lower revascularizations. However, in Rutherford grades 5 and 6, concomitant diabetes does not further worsen the overall poor survival.
Zusatzmaterial
Additional file 1: Table S1. ICD- and OPS codes of diagnoses and procedures.
Additional file 2: Table S2. Impact of Choice of Variables in multivariate Cox regression models on the potential “protective”role of diabetes on long-term Mortality.
Additional file 3: Figure S1. In-hospital complications in patients with vs. without diabetes at Rutherford grade 5 and 6. Complication rates for infection, sepsis, in-hospital amputation, and in-hospital death in patients at Rutherford grade 5 (panel A) and Rutherford grade 6 (panel B) are given as percentages among patient sub-groups with diabetes (DM; orange bars) and without (grey bars). Differences between DM and non-DM sub-groups are considered significant for p-values < 0.05.
Additional file 4: Table S3. Binary Logistic Regression Analysis of In-hospital Outcomes.
Additional file 5: Figure S2. Costing analysis related to Rutherford grade and diabetes status. Costs per case are given in EURO for the in-hospital period (bottom dark bars) and subsequent in-patient costs (upper light bars) in diabetic (DM; orange) and non-DM patients (grey) related to Rutherford grades. Data show about equal in-hospital costs for patients with and without diabetes at the same Rutherford grade, but increased subsequent in-patient costs in patients with DM compared to non-DM CLI patients. Costs are increasing with increasing Rutherford grade.
Literatur
Über diesen Artikel

Weitere Artikel der Ausgabe 1/2017

Cardiovascular Diabetology 1/2017 Zur Ausgabe

Neu im Fachgebiet Innere Medizin

Meistgelesene Bücher aus der Inneren Medizin

2017 | Buch

Rheumatologie aus der Praxis

Entzündliche Gelenkerkrankungen – mit Fallbeispielen

Dieses Fachbuch macht mit den wichtigsten chronisch entzündlichen Gelenk- und Wirbelsäulenerkrankungen vertraut. Anhand von über 40 instruktiven Fallbeispielen werden anschaulich diagnostisches Vorgehen, therapeutisches Ansprechen und der Verlauf …

Herausgeber:
Rudolf Puchner

2016 | Buch

Ambulant erworbene Pneumonie

Was, wann, warum – Dieses Buch bietet differenzierte Diagnostik und Therapie der ambulant erworbenen Pneumonie zur sofortigen sicheren Anwendung. Entsprechend der neuesten Studien und Leitlinien aller wichtigen Fachgesellschaften.

Herausgeber:
Santiago Ewig

Mail Icon II Newsletter

Bestellen Sie unseren kostenlosen Newsletter Update Innere Medizin und bleiben Sie gut informiert – ganz bequem per eMail.

© Springer Medizin 

Bildnachweise