Mortality Related to Diabetic Foot Ulcer: A Comprehensive Review

Abstract

Background: Diabetic Foot Ulcers (DFUs) are a significant and escalating concern in the diabetic population, leading to preventable morbidity, mortality, and reduced quality of life. The myriad of factors associated with DFUs and their outcomes necessitate a comprehensive understanding for improved clinical management and patient outcomes. Aim: This systematic review aimed to collate, assess, and summarise the available literature on the mortality rates and associated factors in patients with DFUs, shedding light on potential areas for intervention, research, and clinical practice enhancements. Methods: A systematic review adhering to PRISMA Statement 2020 guidelines was conducted, using databases such as PubMed, Embase, and Cochrane Library, up to October 25, 2023. Studies addressing patients with DFUs were analysed, focusing on mortality burden and associated factors. Inclusion criteria encompassed observational studies, highlighting therapies/other DFU management strategies in relation to mortality outcomes. Results: Of 781 studies identified, a total of 11 studies were included, pooling in 117,575 participants. Among these studies on DFUs, one reported a 67% healing rate at 12 months, with another underlining Peripheral Arterial Disease (PAD) and cardiovascular diseases on ulcer-free survival. Key associations included adverse outcomes with limb ischemia, ulcer duration, and the predictive abilities of University of Texas (UT) and Site, Ischemia, Neuropathy, Bacterial Infection, and Depth (SINBAD) scores. Trends highlighted the role of a multidisciplinary approach and the presence of limb ischemia and PAD in in-hospital complications. The Wound, Ischemia, and foot Infection (WIfI) stage emerged as a potential prognostic tool, handgrip strength's significance was observed in two studies, and the impact of multidrug-resistant organisms on DFU outcomes was highlighted. Conclusion: DFUs pose a considerable threat to the health and well-being of diabetic patients, with a pronounced impact on mortality rates. This review highlights the importance of multidisciplinary care, early detection, and addressing associated comorbidities. The data suggest an urgent need for enhanced care strategies, proactive approaches, and patient-centric interventions to manage DFUs efficiently and reduce associated mortalities.