Factors associated with In-Hospital Mortality among Patients with Diabetes Admitted for Lower Extremity Infections

Jose Paolo Panuda, Anna Angelica Macalalad-Josue, Myrna Buenaluz-Sedurante

Abstract

Objective. To determine the factors associated with in-hospital mortality among diabetic patients admitted for lower extremity infection.

Methodology. This is a retrospective analysis of diabetic patients with lower extremity infection admitted at the UP-Philippine General Hospital. Data was analyzed through multiple logistic regression after multiple imputation was performed for missing data.

Results. 441 patients with diabetes were included in the analysis, of which 98.1% have Type 2 diabetes mellitus; 58.1% were males and the mean age of the cohort was 56.7 ±11.1 years. The mortality rate was 11.1% over the 3-year period from 2015 to 2017, of which 46% died from myocardial infarction (MI). Multivariate logistic regression showed the following were associated with increased likelihood of in-hospital mortality: non-performance of surgery (OR=4.22, 95%CI 1.10-16.27, p=0.036), elevated BUN (OR=1.06, 95%CI 1.01-1.11, p=0.016), MI (OR=27.19, 95%CI 6.38-115.94, p=0.000), respiratory failure requiring mechanical ventilation (OR=26.14, 95%CI 6.28-108.80, p=0.000), gastrointestinal bleeding (OR=10.08, 95%CI 1.87-54.38, p=0.007), hospital-acquired pneumonia (OR=9.46, 95%CI 2.52-35.51, p=0.001) shock (OR=7.09, 95%CI 2.17-23.22, p=0.001).

Conclusion. In the in-patient setting, morbidity and mortality is high among diabetic patients with lower extremity infection. Non-performance of surgery, elevated BUN, MI, respiratory failure requiring mechanical ventilation, gastrointestinal bleeding, hospital acquired pneumonia and shock are associated with in-hospital death.

Keywords

diabetes, diabetic foot infection, mortality, hospitalization

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