Lower limb wounds in diabetic and non-diabetic patients: survival analysis

Retrospective cohort study of patients with lower limb ulcers treated at a specialized center between 2011 and 2013. Outcome: healing of lower limb injuries in days. The survival function of lower limb wounds and the differences between diabetic and non-diabetic were analyzed. The Log-rank test was used to compare the survival curves between the study groups.

RESULTS

In up to 600 days, 23% of the diabetic patients presented wound healing, while 63% of the non-diabetic patients had their wounds healed, with a statistically significant difference in survival curves in comparison between the groups. The Hazard Ratios (RH) of healing were lower for diabetic patients (HR = 0.13, 95% CI = 0.02-0.97).

CONCLUSION

The results show that there is a delay in wound healing in diabetic patients.

Keywords:
Wound healing; Diabetes mellitus; Survival analysis; Incidence; Epidemiology

Variables	Sample
	n^* * Number of individuals.	%
Gender
Male	33	42.3
Female	45	57.7
Age range (years)
18-65	24	30.8
>65	54	69.2
BMI
Not overweight	22	29.7
Overweight	52	70.3
Education
Incomplete secondary education to complete higher education	25	37.9
Illiterate to complete primary education	41	62.1
Smoking
Non-smoker	49	63.6
Smoker	3	3.9
Ex-smoker	25	32,5

Variables	Sample
Variables	n^* * Number of individuals	(%)
Arterial ulcer
Absence	48	61.5
Presence	30	38.5
Venous ulcer
Absence	40	51.3
Presence	38	48.7
Neuropathic ulcer
Absence	53	68
Presence	25	32.1
Unna boot
Used	22	28.2
Did not use	56	71.8
Compressive therapy
Used	51	65.4
Did not use	27	34.6
Bypass
Did not undergo	73	93.6
Underwent	5	6.41
Angioplasty
Did not undergo	57	73.1
Underwent	21	26.9
Surgical debridement
Did not undergo	64	82.1
Underwent	14	17.9
Minor amputation
Did not undergo	66	84.6
Underwent	12	15.4
Major amputation
Did not undergo	75	96.2
Underwent	3	3.8
Skin grafting
Did not undergo	65	83.3
Underwent	13	16.7

Variables	Total sample	Diabetics	Non diabetics
Gender
Male	0.74	0.57	1.12
Female	1.2	0.81	1.8
Age range (years)
18-65	0.92	0.76	1.17
>65	0.97	0.62	1.74
BMI
Not overweight	0.85	0.6	1.28
Overweight	0.92	0.66	1.44
Education
Incomplete secondary education to complete higher education	0.85	0.79	1.09
Illiterate to complete primary education	0.94	0.64	1.37
Smoking
Non-smoker	1.13	0.86	1.76
Smoker	1.13	1,61	0.87
Ex-smoker	0.67	0.3	1.33
Arterial ulcer
Absence	1.11	0.84	1.4
Presence	0.72	0.52	1.9
Venous ulcer
Absence	0.61	0.55	10.99
Presence	1.35	1.24	1.39
Neuropathic ulcer
Absence	1.11	0. 1	1.48
Presence	0,63	0,64	-
Unna Boot
Did not use	0.83	0.67	2.62
Used	1.17	0.68	1.26
Compressive therapy
Used	0.72	0.64	1.34
Did not use	1.53	1.62	1.53
Bypass
Did not undergo	0.99	0.7	1.54
Underwent	0.64	0.47	0.98
Angioplasty
Did not undergo	1.16	0.92	1.53
Underwent	0.4	0.17	0.98
Surgical Debridement
Did not undergo	1.08	0.85	1.47
Underwent	0.49	0.21	1.58
Minor amputation
Did not undergo	1.11	0.82	1.48
Underwent	0.35	0.35	-
Major amputation
Did not undergo	0.98	0.71	1.48
Underwent	-	-	-
Skin grafting
Did not undergo	0.98	0.69	2.36
Underwent	0.88	0.53	0.99

Variables	Total Sample		Diabetics		Non-diabetics
Variables	HR^* * Hazard Ratio;	IC95%^ Confidence intervals of 95%. Confidence interval of 95% in bold - Statistical significance.	HR^* * Hazard Ratio;	IC95%^ Confidence intervals of 95%. Confidence interval of 95% in bold - Statistical significance.	HR^* * Hazard Ratio;	CI 95%^* ** Confidence intervals of 95%. Confidence interval of 95% in bold - Statistical significance.
Age range (years)
18-65^* * Hazard Ratio;	-	-	-	-	-	-
> 65	1.05	0.47-2.32	0.81	0.26-2.56	1.49	0.50-4.45
BMI
Not overweight^* * Hazard Ratio;	-	-	-	-	-	-
Overweight	1.08	0.44-2.60	1.11	0.30-4.17	1.13	0.35-3.67
Education
Incomplete secondary education to complete higher education^* * Hazard Ratio;	-	-	-	-	-	-
Illiterate to complete primary education	1.10	0.45-2.70	0.82	0.25-2.68	1.25	0.27-5.80
Smoking
Nonsmoker^* * Hazard Ratio;	-	-	-	-	-	-
Smoker	0.99	0.23-4.32	1.87	0.24-14.78	0.50	0.06-3.97
Ex-smoker	0.60	0.25-1.44	0.35	0.08-1.63	0.76	0.25-2.32
Arterial ulcer
Absence^* * Hazard Ratio;	-	-	-	-	-	-
Presence	0.65	0.28-1.49	0.62	0.20-1.97	1.36	0.38-4.87
Venous ulcer
Absence^* * Hazard Ratio;	-	-	-	-	-	-
Presence	2.20	0.98-4.90	2.25	0.68-7.49	0.13	0,02-0,97
Neuropathic ulcer
Absence^* * Hazard Ratio;	-	-	-	-	-	-
Presence	0.57	0.22-1.42	0.89	0.29-2.77	-	-
Unna boot
Did not use^* * Hazard Ratio;	-	-	-	-	-	-
Used	1.40	0.64-3.04	1.01	0.13-7.84	0.48	0.15-1.54
Compressive therapy
Did not use^* * Hazard Ratio;	-	-	-	-	-	-
Used	2.13	0.99-4.61	2.53	0.33-19.64	1.14	0.32-4.09
Bypass
Did not undergo^* * Hazard Ratio;	-	-	-	-	-	-
Underwent	0.64	0.15-2.72	0.68	0.09-5.24	0.64	0.08-4.87
Angioplasty
Did not undergo^* * Hazard Ratio;	-	-	-	-	-	-
Underwent	0.34	0.10-1.14	0.18	0.02-1.41	0.82	0.18-3.67
Surgical debridement
Did not undergo^* * Hazard Ratio;	-	-	-	-	-	-
Underwent	0.45	0.13-1.50	0.24	0.03-1.89	1.08	0.24-4.83
Minor amputation
Did not undergo^* * Hazard Ratio;	-	-	-	-	-	-
Underwent	0.31	0.07-1.34	0.43	0.09-1.95	-	-
Major amputation
Did not undergo^* * Hazard Ratio;	-	-	-	-	-	-
Underwent	0.00	-	0.00	-	-	-
Skin grafting
Did not undergo^* * Hazard Ratio;	-	-	-	-	-	-
Underwent	0.90	0.37-2.13	0.77	0.10-6.00	0.42	0.14-1.21

Universidade Federal do Rio Grande do Sul. Escola de Enfermagem Rua São Manoel, 963 -Campus da Saúde , 90.620-110 - Porto Alegre - RS - Brasil, Fone: (55 51) 3308-5242 / Fax: (55 51) 3308-5436 - Porto Alegre - RS - Brazil
E-mail: revista@enf.ufrgs.br

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[1] Corresponding author:
Marina Ferreira de Oliveira. oliveira.marina21@gmail.com