Assessment of severity of the patients' condition in diabetes mellitus, complicated with necrotic-inflammatory lesions of the foot

Abstract

Aim. Assessment of severity of the patients' condition in diabetes mellitus, complicated by necrotic-inflammatory lesions of the foot, with repeated partial amputations, by the modified APACHE II system. Material and Methods. The results of the assessment of severity of condition were analyzed in 118 patients with diabetes mellitus, complicated by necrotic-inflammatory lesions of the foot, with repeated partial amputations, by the modified APACHE II system (the Acute Physiology and Chronic Health Evaluation) for the period of 2009-2014 in Lviv regional clinical hospital. For a comparative analysis of severity of the patients' condition in diabetes mellitus, complicated by necrotic-inflammatory lesions of the foot, with repeated partial amputations, all patients were divided into two groups: the first, main, group included 73 patients with diabetes mellitus who were hospitalized 136 times (49 men and 24 women, mean age 64,9±0,8 years) and underwent 75 large amputations of the lower limb after 194 repeated partial amputations; the second, control, group included 45 patients with diabetes mellitus, hospitalized 67 times (25 men and 20 women, mean age 66,0±1,0 years), who uderwent 47 large amputations of the lower limb after 48 repeated partial amputations. Results and Discussion. Seventy-three patients of the first group, who underwent 75 large amputations of the lower limb after 194 repeated partial amputations, had higher average score by modified APACHE II system (40,4±0,6) compared to average score in 45 patients of the second group, who underwent 47 large amputations of the lower limb simultaneously or after one partial amputation of the foot (32,7±0,7) (p<0,001). Thus, increasing the frequency of reoperations worsens the patients' condition. Obviously, indications for large amputation of the lower limb must be determined immediately, using the scoring of the severity of the patients' condition by a modified APACHE II system, as well as considering blood circulation of the limbs, spreading of necrotic-inflammatory lesions of the foot, signs of sepsis and other complications of diabetes mellitus and concomitant diseases. The results are worse when large amputation of the lower limb is performed after repeated partial amputations, with progressive deterioration of the patient's condition. Conclusion. Comprehensive assessment of general results of clinical, laboratory, diagnostic imaging, intraoperative observations, morphological studies, and surgical interventions in patients with diabetes mellitus, complicated with necrotic-inflammatory lesions of the foot, with repeated partial amputations, by a modified APACHE II system allows us to estimate the severity of the patient's condition, determine prognosis and appropriate treatment strategy.

Keywords

• diabetes mellitus, complications, necrotic-inflammatory lesions of the foot, modified apache ii system, repeated partial amputations, prognosis