Health-Related Quality of Life Predicts Major Amputation and Death, but Not Healing, in People With Diabetes Presenting With Foot Ulcers: The Eurodiale Study
Por:
Siersma, V, Thorsen, H, Holstein, PE, Kars, M, Apelqvist, J, Jude, EB, Piaggesi, A, Bakker, K, Edmonds, M, Jirkovska, A, Mauricio, D, Tennvall, GR, Reike, H, Spraul, M, Uccioli, L, Urbancic, V, van Acker, K, van Baal, J, Schaper, NC
Publicada:
1 mar 2014
Resumen:
OBJECTIVELow health-related quality of life (HRQoL) has been consistently reported to be associated with poor prognosis for a variety of health outcomes in various settings. We aimed to evaluate whether HRQoL in patients presenting with new diabetic foot ulcers (DFUs) has prognostic significance for ulcer healing, major amputation, and death.RESEARCH DESIGN AND METHODSWe followed 1,088 patients with new DFUs presenting for treatment at one of the 14 centers in 10 European countries participating in the Eurodiale (European Study Group on Diabetes and the Lower Extremity) study, prospectively until healing (76.9%), major amputation (4.6%), or death (6.4%) up to a maximum of 1 year. At baseline, patient and ulcer characteristics were recorded as well as EQ-5D, a standardized instrument consisting of five domains and a visual analog scale for use as a measure of HRQoL. The prognostic influence of the EQ-5D domains was evaluated in multivariable Cox regression analyses on the time-to-event data, adjusting for baseline clinical characteristics of the ulcer and comorbidities.RESULTSWhile predictive effects of HRQoL, adjusted for possible confounders, were absent for healing, decreased HRQoL, especially in the physical domains, was statistically significant for major amputation (mobility, self-care, usual activities) and death (self-care, usual activities, pain/discomfort).CONCLUSIONSLow HRQoL appears to be predictive for major amputation and death, but high HRQoL does not increase healing. Future studies into the influence of HRQoL on ulcer outcome are important in attempts to decrease treatment failure and mortality.
Filiaciones:
Siersma, V:
Univ Copenhagen, Res Unit Gen Practice, Copenhagen, Denmark
Univ Copenhagen, Dept Publ Hlth, Sect Gen Practice, Copenhagen, Denmark
Thorsen, H:
Univ Copenhagen, Res Unit Gen Practice, Copenhagen, Denmark
Univ Copenhagen, Dept Publ Hlth, Sect Gen Practice, Copenhagen, Denmark
Holstein, PE:
Bispebjerg Hosp, Copenhagen Wound Healing Ctr, Copenhagen, Denmark
Kars, M:
Maastricht Univ, Med Ctr, Dept Internal Med, Div Endocrinol, Maastricht, Netherlands
Maastricht Univ, Med Ctr, Res Sch CAPHRI, Maastricht, Netherlands
Apelqvist, J:
Univ Malmo, Dept Endocrinol, Malmo, Sweden
Jude, EB:
Tameside Gen Hosp, Diabet Ctr, Ashton Under Lyne, England
Piaggesi, A:
Azienda Osped Univ Pisana, Dipartimento Area Med, Sez Dipartimentale Piede Diabet, Pisa, Italy
Bakker, K:
IDF Consultat Sect, Heemstede, Netherlands
Int Working Grp Diabet Foot, Heemstede, Netherlands
Edmonds, M:
Kings Coll Hosp London, Dept Diabet, London SE5 9RS, England
Jirkovska, A:
Inst Clin & Expt Med, Diabet Ctr, Prague, Czech Republic
Mauricio, D:
Autonomous Univ Barcelona, Hosp St Pau, Dept Endocrinol & Nutr, Barcelona, Spain
Tennvall, GR:
Swedish Inst Hlth Econ, Lund, Sweden
Reike, H:
Mariannen Hosp, Innere Abt, Werl, Germany
Spraul, M:
Mathias Spital, Dept Diabet, Rheine, Germany
Uccioli, L:
Policlin Tor Vergata, Dept Internal Med, Rome, Italy
Urbancic, V:
Univ Med Ctr, Dept Endocrinol, Ljubljana, Slovenia
van Acker, K:
H Familie Ziekenhuis, Rumst, Belgium
Ctr Sante Fagnes, Dept Endocrinol, Rumst, Belgium
H Familie Ziekenhuis, Chimay, Belgium
Ctr Sante Fagnes, Dept Endocrinol, Chimay, Belgium
van Baal, J:
Twenteborg Ziekenhuis, Dept Surg, Almelo, Netherlands
Schaper, NC:
Maastricht Univ, Med Ctr, Dept Internal Med, Div Endocrinol, Maastricht, Netherlands
Maastricht Univ, Med Ctr, Res Sch CAPHRI, Maastricht, Netherlands
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