Analyzing Predictive Factors for Major Lower Extremity Amputations in Diabetic Foot Infection: A Prospective Study

Introduction: Diabetic foot is a common entity in developing nations. Amputation due to diabetic foot infection adds up burden to an individual as well as to the economy of the country. Moreover, there are no separate criteria/scoring for detecting early unsalvageable limb. Materials and Methods: This is a prospective observational study which was carried out in 120 patients who were admitted with diabetic foot infections in Government Rajaji Hospital, Madurai for a period of 18-month and they were observed for gangrene, pulse status, ankle-brachial index (ABI), infection patterns, osteomyelitis, hemoglobin (Hb), total white blood cells (WBC) count, erythrocyte sedimentation rate (ESR), C-reactive protein (CRP), Lipid profile Lipoprotein (LDL), and cardiac status at the time of admission. A scoring system was devised using these parameters. Results: Out of these parameters -gangrene, pulse status, infection, osteomyelitis, and ABI were found to be major contributory factors and Hb, duration of diabetes, total WBC count, CRP, cardiac status, ESR, and lipid profile were found to be minor contributory/predictive factors. In this scoring system, patients with score 13 and below were managed by conservative procedures, those with 14-17 went for minor amputation and scores 18 and above went for major amputation. Conclusion: Using our scoring system, we can separate the patient who is more likely to go for amputations as early as possible and provide them an early apt intervention to save his/her limb.