Presentation Abstract

Session: The Burden of Diabetic Foot Disease (With Roger Pecoraro Award Lecture)
Abstract Number: 116-OR
Title: Validation of SIRS and Severe Diabetic Foot Infections
Presentation Start: 6/22/2013 4:30:00 PM
Presentation End: 6/22/2013 4:45:00 PM
Authors: KIMBERLEE B. HOBIZAL, DANE K. WUKICH, Pittsburgh, PA.
Abstract: Diabetic foot infections (DFI) are limb threatening complications and proper classification of DFI severity is important in establishing the need for hospitalization and and risk of amputation. In 2012, the Infectious Disease Society of America (IDSA) recommended using the presence of the Systemic Inflammatory Response Syndrome (SIRS) as a method of distinguishing severe DFI from moderate DFI. This new recommendation has not been validated. Our hypothesis is that patients hospitalized with DFI who manifest SIRS would have longer hospital stays and higher rates of major amputation than patients who don’t manifest SIRS. Inpatient and outpatient electronic medical records identified 114 patients who were hospitalized for DFI over a six year period.. Severe DFI was defined as having two or more objective findings of systemic toxicity at the time of initial assessment. Results: see Table. The length of stay was significantly longer for patients with a severe infection than those with a moderate infection. Significantly more major amputations (BKA) were required in patients with severe infections ( p=0.0078). A non-significant trend indicating higher rates of any amputations (major and minor) was observed in patients with severe infections (p= 0.059). The use SIRS to discriminate moderate from severe DFI is valid in hospitalized patients. Patients with DFI may not mount the normal signs of systemic toxicity and those with moderate infections are still at risk for minor and major amputations.
ResultsModerate (N=62)Severe (N=52)P value
Mean age in years59.1 ± 11.456.9 ± 11.4P = 0.3225
SIRS

T >38° C or < 36°

HR > 90 /min

RR > 20/min

WBC >12,000 or < 4,000
Less than 2 signs of systemic toxicityTwo or more signs of systemic toxicity
Gender
Male/Females
45/1743/9P = 0.26
Duration of diabetes in years14.3± 10.916.1 ± 9.4P= 0.370
Insulin Use
Number ( %)
42 (67.7%)41 (78.8%)P=0.21
Diabetes Type 1/210/524/48P= 0.25
Hemoglobin A1c %9.1 ± 2.58.5 ± 2.2P = 0.23
NeuropathyNumber (%)62 (100%)52 (100%)P= 1.00
BMI31.0± 5.932.5± 8.0P =0.2570
Peripheral Artery Disease , Number (%)27 (43.5%)22 (42.3%)P = 1.00
Length of Stay in Days
± SD
8.0 ± 6.810.9 ± 6.6P=0.027
Major amputation (%)3 (4.8%)14(26.9%)P=0.0078
Minor Amputation (%)20 (32.3%)17 (32.7%)P= 1.000
Any Amputation (%25 (40.3%)31 (59.6%)P = 0.059





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