Jornal Vascular Brasileiro
http://www.jvascbras.org/article/doi/10.1590/1677-5449.010717
Jornal Vascular Brasileiro
Original Article

Fatores de risco para mortalidade em pacientes submetidos a amputações maiores por pé diabético infectado

Risk factors for mortality among patients undergoing major amputations due to infected diabetic feet

Natália Anício Cardoso, Ligia de Loiola Cisneros, Carla Jorge Machado, Ricardo Jayme Procópio, Túlio Pinho Navarro

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Resumo

Contexto: A lesão no pé de pacientes com diabetes é um importante problema de saúde pública que frequentemente está associado a amputações em membros inferiores e mortalidade nessa população. Objetivos: Investigar os fatores de risco associados a mortalidade em pacientes com pé diabético infectado submetidos a amputação maior. Métodos: Estudo observacional, retrospectivo e caso-controle. Amostra composta por 78 pacientes com pé diabético e úlcera infectada submetidos a amputação maior em um serviço de cirurgia vascular em um hospital universitário no período de 5 anos. Resultados: A média de idade da amostra estudada foi de 63,8 ± 10,5 anos, com 54 (69,2%) pacientes do sexo masculino, com creatinina sérica média de 2,49 ± 2,4 mg/dL e hemoglobina sérica média de 7,36 ± 1,7 g/dL. Houve 47,4% de reinternação. Foi realizada amputação transtibial em 59,0% e transfemoral em 39,7% da amostra estudada. Nesta amostra, 87,2% dos pacientes apresentaram cultura positiva, predominantemente monomicrobiana (67,9%), e 30,8% apresentaram infecção hospitalar da úlcera. Os gêneros de bactérias mais frequentes foram Acinetobacter spp. (24,4%), Morganella spp. (24,4%) e Proteus spp. (23,1%). Nenhum gênero bacteriano foi identificado como fator de risco para óbito. O nível de creatinina ≥ 1,3 mg/dL (OR 17,8; IC 2,1-150) e a amputação transfemoral (OR 4,5; IC: 1,3-15,7) foram fatores de risco para o óbito. Conclusões: Os níveis séricos de creatinina ≥ 1,3 mg/dL e amputação transfemoral foram fatores de risco para óbito.

Palavras-chave

pé diabético; úlcera do pé; infecção; mortalidade

Abstract

Background: Foot ulcers in patients with diabetes are a major public health problem and are often associated with lower limbs amputation and mortality in this population. Objectives: To investigate the risk factors associated with mortality in patients with infected diabetic foot ulcers and major lower limb amputations. Methods: This was an observational, retrospective, case-control study with a sample of 78 patients with infected diabetic foot ulcers who had major lower limb amputations at a Vascular Surgery Service at a university hospital. Results: The mean age of the study sample was 63.8 ± 10.5 years, 54 (69.2%) were male, mean serum creatinine was 2.49 ± 2.4 mg/dL and mean serum hemoglobin was 7.36 ± 1.7 g/dL. There was a 47.4% rate of readmissions to the same hospital. Transtibial amputation was performed in 59.0%; and transfemoral amputation in 39.7% of the sample. In this sample, 87.2% had a positive culture, predominantly (68.0%) monomicrobial and nosocomial infection of ulcers was observed in 30.8%. The most common bacterial genera were Acinetobacter spp. (24.4%), Morganella spp. (24.4%) and Proteus spp. (23.1%). No bacterial genus was identified as a predictor of death. Creatinine level ≥ 1.3 mg/dL (OR 17.8; IC 2.1-150) and transfemoral amputation (OR 4.5; IC: 1.3-15.7) were associated with death. Conclusions: Serum creatinine levels ≥ 1.3 mg/dL and transfemoral amputation were risk factors for death.

Keywords

diabetic foot; foot ulcer; infection; mortality

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