Cited by 131Diabetic Foot Ulcer Assessment and ManagementPeripheral Artery Disease ManagementWound Healing and Treatments

Performance of prognostic markers in the prediction of wound healing or amputation among patients with foot ulcers in diabetes: a systematic review.

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Brownrigg, J. R. W., Hinchliffe, R. J., Apelqvist, J., Boyko, E. J., Fitridge, R., Mills, J. L., Reekers, J., Shearman, C. P. +3 more·2016·Diabetes/Metabolism Research and Reviews

Abstract

Prediction of wound healing and major amputation in patients with diabetic foot ulceration is clinically important to stratify risk and target interventions for limb salvage. No consensus exists as to which measure of peripheral artery disease (PAD) can best predict outcomes. To evaluate the prognostic utility of index PAD measures for the prediction of healing and/or major amputation among patients with active diabetic foot ulceration, two reviewers independently screened potential studies for inclusion. Two further reviewers independently extracted study data and performed an assessment of methodological quality using the Quality in Prognostic Studies instrument. Of 9476 citations reviewed, 11 studies reporting on 9 markers of PAD met the inclusion criteria. Annualized healing rates varied from 18% to 61%; corresponding major amputation rates varied from 3% to 19%. Among 10 studies, skin perfusion pressure ≥ 40 mmHg, toe pressure ≥ 30 mmHg (and ≥ 45 mmHg) and transcutaneous pressure of oxygen (TcPO2 ) ≥ 25 mmHg were associated with at least a 25% higher chance of healing. Four studies evaluated PAD measures for predicting major amputation. Ankle pressure < 70 mmHg and fluorescein toe slope < 18 units each increased the likelihood of major amputation by around 25%. The combined test of ankle pressure < 50 mmHg or an ankle brachial index (ABI) < 0.5 increased the likelihood of major amputation by approximately 40%. Among patients with diabetic foot ulceration, the measurement of skin perfusion pressures, toe pressures and TcPO2 appear to be more useful in predicting ulcer healing than ankle pressures or the ABI. Conversely, an ankle pressure of < 50 mmHg or an ABI < 0.5 is associated with a significant increase in the incidence of major amputation.

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  • In the absence of other associated diagnoses, an erythrocyte sedimentation rate greater than 70 mm/h can be helpful in improving diagnostic accuracy for osteomyelitis (likelihood ratio, 11).

    “In the absence of other associated diagnoses, an erythrocyte sedimentation rate greater than 70 mm/h can be helpful in improving diagnostic accuracy for osteomyelitis (likelihood ratio, 11).40,41”

    From Diabetic Foot Ulcers (2023) · cites this paper as [40]

    The Data extraction and quality assessment passage (p. 130) discusses likelihood ratios for predicting wound healing or amputation, not diagnosing osteomyelitis. Searches for erythrocyte sedimentation rate, ESR, and osteomyelitis found no passage addressing the claimed >70 mm/h threshold or likelihood ratio of 11. (LLM, conf=0.77)

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Authors
Brownrigg, J. R. W., Hinchliffe, R. J., Apelqvist, J., Boyko, E. J., Fitridge, R., Mills, J. L., Reekers, J., Shearman, C. P., Zierler, R. E., Schaper, N. C., & On behalf International Working Group on the Diabetic Foot (IWGDF)
Affiliations
  • St George’s University Hospitals NHS Foundation Trust (GB)
  • Department of Endocrinology University Hospital of Malmö Malmö Sweden
  • University of Washington (US)
  • The University of Adelaide (AU)
  • Baylor College of Medicine (US)
  • Amsterdam UMC Location University of Amsterdam (NL)
  • University Hospital Southampton NHS Foundation Trust (GB)
  • Maastricht University Medical Centre (NL)
Corresponding author
Hinchliffe, R. J.
Venue
Diabetes/Metabolism Research and Reviews
Publisher
Wiley
Published
2016-01
Volume
32
Issue
S1
Pages
128-135
ISSN
  • 1520-7552 (ISSN-L)
  • 1520-7560
OpenAlex
W3134167119
Cited by
130
References
39
Citations by year
2026: 6 · 2025: 8 · 2024: 9 · 2023: 20 · 2022: 7 · 2021: 12 · 2020: 21 · 2019: 14 · 2018: 16 · 2017: 4 · 2016: 11 · 2015: 2
FWCI
1.66
Type
journal article
Language
en
Open access
Locations
  • Diabetes/Metabolism Research and Reviews (publishedVersion)
  • PubMed (publishedVersion)
  • Research Publications (Maastricht University) (publishedVersion, other-oa)
  • Pure Amsterdam UMC (acceptedVersion, other-oa)
  • Data Archiving and Networked Services (DANS) (submittedVersion)
  • Lund University Publications (Lund University) (submittedVersion)
  • Research Publications (Maastricht University) (submittedVersion)
Funders
Medical Research Council (MR/K025643/1)
Topics
  • Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Diabetic Foot Ulcer Assessment and Management
  • Health Sciences › Medicine › Surgery › Peripheral Artery Disease Management
  • Health Sciences › Medicine › Rehabilitation › Wound Healing and Treatments
Keywords
diabetic foot ulcer, wound healing prediction, major amputation, peripheral arterial disease, prognostic factors, skin perfusion pressure, toe pressure, transcutaneous oxygen tension, ankle pressure, ankle-brachial index, limb salvage
MeSH terms
Amputation, Surgical, Combined Modality Therapy, Foot, Humans, Prognosis, Regional Blood Flow, Skin, Wound Healing, Biomarkers, Diabetic Foot, Risk Assessment, Evidence-Based Medicine, Limb Salvage, Therapies, Investigational, Precision Medicine, Endovascular Procedures

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