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Protein calorie malnutrition is associated with higher risk for amputation in diabetic patients with lower extremity ulcers
Yusuf Surucu, MD; Muhammad Saad Hafeez, MBBS; Yadira Villalvazo, MD; Pooja Humar, BS; Elizabeth A. Moroni, MD MHA; Kripa Venkatakrishnan, MPH, Joseph Mocharnuk, BS; Brodie Parent MD, MS
Univesity of Pittsburgh
2023-02-10
Presenter: Yusuf Surucu
Affidavit:
I certify that the material proposed for presentation in this abstract has not been published in any scientific journal or previously presented at a major meeting.
Director Name: J. Peter Rubin, MD, MBA
Author Category: Fellow Plastic Surgery
Presentation Category: Clinical
Abstract Category: General Reconstruction
Introduction:
Lower extremity ulcers are associated with significant morbidity, high healthcare costs and amputation risk. We hypothesized that nutritional status, defined by serum albumin, would be associated with worse outcomes.
Methods:
In this retrospective cohort study, all diabetic patients presenting to wound care clinics at a large multi-hospital single healthcare network were included (2016-2022). Baseline demographic data were gathered, and patients with missing albumin levels were excluded. Patients were divided into low albumin (LA;<3.5g/dL) and normal albumin (NA;≥3.5g/dL) groups. Multivariate Cox proportional hazards models were generated to assess association between albumin and time-to-amputation, adjusting for clinically and statistically significant variables.
Results:
We identified 2,922 patients, 1,556(53.25%) LA and 1,366(46.75%) NA. LA patients were more likely to be older (67.4±12.8vs66.3±12.7,p=0.019), female (42.6%vs36.3,p<0.01) and living in areas with higher ADI (70.7±16.2vs68.9±16.7,p=0.002). Baseline glycemic control and glomerular filtration rate were worse in LA groups (HbA1c:7.9±2.1vs7.7±1.9,p=0.049;GFR:52.2±24.9vs60.9±22.8,p<0.01). LA patients had higher total wound count (3.4±2.3vs3.0±2.1,p<0.001) and more likely to have multiple wounds (74.4%vs69.1%,p=0.001).
Mean follow-up duration was 29.2±19.4 months. Normal albumin was associated with greater wound healing (55.9%vs44.7%,p=0.001) in patients with single wounds.
Amputation-free survival was better in NA patients at all time points (3months:96.1±0.5%vs91.5±0.7%;12months:91.9±0.8%vs85.1±0.9%;24months:87.5±1.0%vs80.7±1.1%;p<0.01). On adjusted analysis, normal albumin continued to be associated with healing and limb salvage(adjusted HR=0.66[95%C.I.0.54-0.81],p<0.01).
Conclusions:
In diabetic patients with lower extremity ulcers, low albumin levels were associated with delayed healing and greater amputation risk. Our findings reiterate the importance of nutritional status in wound healing and identify a target for limb salvage teams in care of this patient population.
