Thepredictivevalueofhomocysteinefordiabeticfootamputationintheelderly

Abstract:

Objective：Toinvestigatetheriskfactorsfordiabeticfootamputationintheelderly，aswellasthepredictivevalueofhomocysteine（Hcy）foramputation.Methods：Theretrospectivestudyincluded134eligibleelderlypatientswithdiabeticfoot，whowerehospitalizedintheDepartmentofEndocrinology，JinzhouCentralHospital，fromDecember2012toFebruary2018.Accordingtothelimbstatus，thepatientsweredividedintoamputationgroup（AMPgroup）andnon-amputationgroup（NAMPgroup）.Theinter-groupdatawereanalyzedwithttest，Mann-Whitneytest，andchi-squaretest；theriskfactorsforamputationinelderlypatientswithdiabeticfootwereanalyzedwithmultivariateregression.Thereceiveroperatingcharacteristic（ROC）curvewasusedtodeterminethepredictivevalueofHcyforamputationintheelderlypatientswithdiabeticfoot.Results：Inthe134elderlypatientswithdiabeticfoot，90werenon-amputated，and44wereamputated；theamputationratewas32.83%.ThemeanlengthofhospitalstayintheAMPgroupwassignificantlylongerthanthatintheNAMPgroup（P<0.01）.Theserumalbuminlevelandankle-brachialindexintheAMPgroupweresignificantlylowerthanthoseintheNAMPgroup（P<0.01）.TheHcylevelandwhitebloodcell（WBC）countintheAMPgroupweresignificantlyhigherthanthoseintheNAMPgroup（P<0.01）.MultivariatelogisticregressionanalysisshowedthatHcy（OR=1.168，95%CI＝1.096-1.244）andWBC（OR=1.186，95%CI＝1.039-1.354）wereindependentriskfactorsforamputationinelderlypatientswithdiabeticfoot.TheareaundertheROCcurverepresentingthepredictivevalueofHcyfordiabeticfootamputationintheelderlywas0.812（95%CI＝0.731-0.893，P<0.01）.Attheoptimalcut-offvalueof22.5?滋mol/L，Hcyhadasensitivityof63.60%，aspecificityof90.00%，anaccuracyof81.34%，apositivepredictivevalueof75.67%，andanegativepredictivevalueof83.50%inpre－dictingamputation.TheamputationrateofpatientswithHcylevelshigherthanthecut-offvaluewas75.67%，whichwas2.30timestheoverallamputationrate.Conclusion：HighHcyisanindependentriskfactorfordiabeticfootamputationintheelderly.WhenHcylevelishigherthan22.5?滋mol/L，ithashighspecificity，positivepredictivevalue，andnegativepredictivevalueinpredictingdiabeticfootamputationintheelderly，withahighoverallcoincidencerate.