Prospective observational study evaluating the predictive value of ankle branchial pressure index on the outcomes of diabetic foot ulcers

Authors

  • Vishnu S. Ravidas Department of General Surgery, Sree Gokulam Medical College and Research Foundation, Venjaramoodu, Trivandrum, Kerala
  • Samadarsi P. Department of General Surgery, Sree Gokulam Medical College and Research Foundation, Venjaramoodu, Trivandrum, Kerala
  • Ajayan G. Department of General Surgery, Sree Gokulam Medical College and Research Foundation, Venjaramoodu, Trivandrum, Kerala

DOI:

https://doi.org/10.18203/2349-2902.isj20202527

Keywords:

Diabetic foot ulcers, Ankle brachial pressure index, ABPI, Peripheral arterial disease, ROC

Abstract

Background: The study was conducted to determine the diagnostic accuracy of ankle branchial pressure index (ABPI) in predicting major amputation and duration of wound healing in diabetic foot ulcers.

Methods: 105 participants (30-85 years) admitted in general surgery inpatient with diabetic foot ulcers during 18 months were enrolled in the present prospective observational study. Institutional ethics committee approved the study and written informed consent was obtained from all study participants. Data was analyzed using R and the tests of significance were chi square test and ANOVA. Area under curve (AUC) of receiver operator characteristic (ROC) was used to describe the diagnostic accuracy of ABPI. P<0.05 was considered statistically significant.

Results: The mean ABPI of study participants was 0.7 with 23.8% participants having normal ABPI. Lower ABPI was associated with longer duration of ulcer healing (p=0.003). All participants with ABPI <0.3 required more than 120 days for wound healing (p<0.001) and required above knee amputation (p<0.001). AUC ROC of ABPI and major amputation is 0.987 with 92.9% sensitivity and 98.9% specificity. Significantly higher proportion of participants with ABPI ≤0.48 underwent major amputation. The AUC of ROC of ABPI on duration of wound healing was 0.953 with 84.9% sensitivity and 98.1% specificity.    

Conclusions: ABPI can be used as a routine tool in all patients with diabetic foot ulcers for screening peripheral arterial disease so that the decision for amputation can be made early during diabetic foot ulcers.

References

Goyal R, Jialal I. Diabetes Mellitus Type 2. In: Stat Pearls. Treasure Island (FL): Stat Pearls Publishing; 2020. Available at http://www.ncbi.nlm.nih.gov/ books/NBK513253. Accessed on 11 March 2020.

Diabetes. Available at https://www.who.int/news-room/fact-sheets/detail/diabetes. Accessed on 13 March 2020.

Kannan R. India is home to 77 million diabetics, second highest in the world. The Hindu 14 November 2019. Available at https://www.thehindu. com/sci-tech/health/india-has-second-largest-number-of-people-with-diabetes/article29975027/ ece. Accessed on 13 March 2020.

Armstrong DG, Boulton AJM, Bus SA. Diabetic Foot Ulcers and Their Recurrence. N Engl J Med. 2017;376(24):2367-75.

Oliver TI, Mutluoglu M. Diabetic Foot Ulcer. In: Stat Pearls. Treasure Island (FL): Stat Pearls Publishing; 2020. Available at http://www.ncbi.nlm. nih.gov/books/NBK537328. Accessed on 11 March 2020.

Singer AJ, Tassiopoulos A, Kirsner RS. Evaluation and Management of Lower-Extremity Ulcers. N Engl J Med. 2018;378(3):302-3.

Alexiadou K, Doupis J. Management of Diabetic Foot Ulcers. Diabetes Ther, 2012. Available at https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3508111. Accessed on 12 March 2020.

Wang CL, Wang M, Liu TK. Predictors for wound healing in ischemic lower limb amputation. J Formos Med Assoc Taiwan Yi Zhi. 1994;93(10):849-54.

Saap LJ, Falanga V. Debridement performance index and its correlation with complete closure of diabetic foot ulcers. Wound Repair Regen Off Publ Wound Heal Soc Eur Tissue Repair Soc. 2002;10(6):354-9.

Willer KA, Harreiter J, Pacini G. Sex and Gender Differences in Risk, Pathophysiology and Complications of Type 2 Diabetes Mellitus. Endocr Rev. 2016;37(3):278-316.

Peternella NFM, Lopes APAT, Arruda GO, Teston EF, Marcon SS. Differences between genders in relation to factors associated with risk of diabetic foot in elderly persons: a cross-sectional trial. J Clin Transl Endocrinol. 2016;6:30-6.

Qaisi AM, Nott DM, King DH, Kaddoura S. Ankle Brachial Pressure Index (ABPI): An update for practitioners. Vasc Health Risk Manag. 2009;5:833-41.

Thiruvoipati T, Kielhorn CE, Armstrong EJ. Peripheral artery disease in patients with diabetes: Epidemiology, mechanisms, and outcomes. World J Diabetes. 2015;6(7):961-9.

Forsythe RO, Jones KG, Hinchliffe RJ. Distal bypasses in patients with diabetes and infrapopliteal disease: technical considerations to achieve success. Int J Low Extrem Wounds. 2014;13(4):347-62.

Singh S, Armstrong EJ, Sherif W, Alvandi B, Westin GG, Singh GD, et al. Association of elevated fasting glucose with lower patency and increased major adverse limb events among patients with diabetes undergoing infrapopliteal balloon angioplasty. Vasc Med Lond Engl. 2014;19(4):307-14.

Downloads

Published

2020-06-25

Issue

Section

Original Research Articles