深层感染性糖尿病足溃疡患者发生重大不良心血管事件的风险增加

IF 8.4 1区 医学 Q1 ENDOCRINOLOGY & METABOLISM Diabetologia Pub Date : 2024-11-07 DOI:10.1007/s00125-024-06316-z
Nick S. R. Lan, Jonathan Hiew, Ivana Ferreira, J. Carsten Ritter, Laurens Manning, P. Gerry Fegan, Girish Dwivedi, Emma J. Hamilton
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引用次数: 0

摘要

目的/假设糖尿病相关足部溃疡(DFU)与心血管风险增加有关,但其机制仍不清楚。炎症和感染是心血管疾病的介质,可能在 DFU 中起重要作用。方法分析了从接受多学科 DFU 服务的患者处收集的数据。深部溃疡的定义是溃疡达到肌肉、肌腱或深层结构。患者被分为四组:不深且无感染(D-/I-)、不深但有感染(D-/I+)、深且无感染(D+/I-)或深且有感染(D+/I+)。重大不良心血管事件(MACE)是指因心肌梗死、中风或短暂性脑缺血发作或心力衰竭而住院。结果 在513名患者中,D-/I-组241人(47.0%),D-/I+组110人(21.4%),D+/I-组35人(6.8%),D+/I+组127人(24.8%)。中位随访时间分别为 381 天(IQR 220-551)和 404 天(IQR 228-576)后,75 例患者(14.6%)发生了 MACE 或全因死亡,46 例患者(9.0%)仅发生了 MACE。感染与较高的 MACE 或全因死亡率(21.5% vs 8.7%;p<0.001)和单纯 MACE(13.5% vs 5.1%;p=0.003)明显相关。D+/I+组的MACE或全因死亡率明显更高(D-/I- 7.9%; D-/I+ 15.5%; D+/I- 14.3%; D+/I+ 26.8%; p<0.001),单纯MACE也明显更高(D-/I- 5.0%; D-/I+ 10.9%; D+/I- 5.7%; D+/I+ 15.7%; p=0.017)。感染和深部溃疡是不良结局的独立预测因素。结论/解释与不深或未感染的 DFU 相比,深部和/或感染的 DFU 与心血管风险增加有关。这些发现提供了一种潜在的机制解释,需要进行研究。
本文章由计算机程序翻译,如有差异,请以英文原文为准。

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Increased risk of major adverse cardiovascular events in patients with deep and infected diabetes-related foot ulcers

Aims/hypothesis

Diabetes-related foot ulceration (DFU) is associated with increased cardiovascular risk, but the mechanisms remain unclear. Inflammation and infection are mediators of CVD, which may be important in DFU.

Methods

Prospectively collected data from patients attending a multidisciplinary DFU service were analysed. A deep ulcer was defined as one that reached muscle, tendon or deeper structures. Patients were categorised into four DFU groups: not deep and no infection (D−/I−), not deep but infected (D−/I+), deep with no infection (D+/I−) or deep with infection (D+/I+). Incident major adverse cardiovascular events (MACE) were defined as hospitalisation for myocardial infarction, stroke or transient ischaemic attack, or heart failure. Survival analyses were performed using the logrank test and multivariate Cox regression.

Results

Of 513 patients, 241 (47.0%) were in the D−/I− group, 110 (21.4%) were in the D−/I+ group, 35 (6.8%) were in the D+/I− group and 127 (24.8%) were in the D+/I+ group. MACE or all-cause mortality occurred in 75 patients (14.6%), and MACE alone occurred in 46 patients (9.0%) after median follow-up of 381 days (IQR 220–551) and 404 days (IQR 228–576), respectively. Infection was associated with significantly higher MACE or all-cause mortality (21.5% vs 8.7%; p<0.001) and MACE alone (13.5% vs 5.1%; p=0.003). MACE or all-cause mortality was significantly higher in the D+/I+ group (D−/I− 7.9%; D−/I+ 15.5%; D+/I− 14.3%; D+/I+ 26.8%; p<0.001), as was MACE alone (D−/I− 5.0%; D−/I+ 10.9%; D+/I− 5.7%; D+/I+ 15.7%; p=0.017). Infection and a deep ulcer were independent predictors of adverse outcomes.

Conclusions/interpretation

Deep and/or infected DFUs are associated with increased cardiovascular risk compared with DFUs that are not deep or infected. These findings provide a potential mechanistic explanation that requires investigation.

Graphical Abstract

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来源期刊
Diabetologia
Diabetologia 医学-内分泌学与代谢
CiteScore
18.10
自引率
2.40%
发文量
193
审稿时长
1 months
期刊介绍: Diabetologia, the authoritative journal dedicated to diabetes research, holds high visibility through society membership, libraries, and social media. As the official journal of the European Association for the Study of Diabetes, it is ranked in the top quartile of the 2019 JCR Impact Factors in the Endocrinology & Metabolism category. The journal boasts dedicated and expert editorial teams committed to supporting authors throughout the peer review process.
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