Mortality Prediction Model in Patients with Diabetic Foot Ulcer: A Case-Control Study from a Tertiary Referral Hospital in Surabaya, Indonesia

Abstract

Objective: Diabetic foot ulcers (DFUs) are a diabetes mellitus (DM) complication with a high mortality rate. This research aimed to demonstrate a mortality prediction model in patients with DFUs. Material and Methods: This research conducted a case-control study based on secondary data from the medical records of DFU patients in Dr. Soetomo General Hospital, a tertiary referral hospital in Surabaya, Indonesia, between 2016-2018. The association between various risk factors and mortality was analyzed using bivariate and multivariate analyses to make a mortality prediction model. Results: 358 subjects (179 cases and 179 controls) were included in the final analysis. Septic shock was the major cause of DFU death. Both bivariate and multivariate analyses determined that 5 independent variables were associated with the mortality in DFU patients, namely albumin level (p-value<0.001 OR 16.52 CI 95% 3.42–79.86), sepsis (p-value<0.001 OR 23.47 CI 95% 5.80–26.85), renal function impairment (p-value<0.001 OR 3.41 CI 95% 1.87–6.21), cardiovascular complications (p-value<0.001 OR 2.93 CI 95% 1.64–5.25), and the severity level of the ulcers using Wagner’s classification (p-value<0.001 OR 6.80 CI 95% 3.77–12.27). The mortality prediction model showed a maximum score of 7, indicating a 98.4% mortality risk. Conclusion: Low albumin level, sepsis, renal function impairment, cardiovascular complications, and Wagner’s severity level IV–V of the DF ulcers were the predictors of mortality in DFUs.

Keywords

• diabetes mellitus
• diabetic foot ulcer
• mortality
• risk factors