Predicting Major Amputation Rates in Diabetic Hindfoot Ulcers With Critical Infection and Ischemia: A Risk-Factor-Based Model.
4 affiliations
- 1Department of Plastic Surgery, Taean Public Health Office, Taean, Korea.
- 2Diabetic Wound Center and Department of Plastic Surgery, Korea University Guro Hospital, Seoul, Korea.
- 3Department of Plastic Surgery, Korea University College of Medicine, Seoul, Korea. [email protected].
- 4Department of Plastic Surgery, Korea University College of Medicine, Seoul, Korea.
Abstract
Background
Diabetic hindfoot ulcers pose a substantially greater risk of progressing to major amputation than forefoot or midfoot ulcers. Patients with these ulcers often experience severe psychological distress at the prospect of major limb loss. Consequently, patients, their families, and healthcare professionals prioritize understanding the actual risk of major amputation based on the patient's current clinical status. However, practical tools addressing this critical and common concern remain limited. In a previous preliminary study, we proposed a model for predicting major amputation rates in diabetic hindfoot ulcers. Nonetheless, that model, which relied solely on ischemia and infection, demonstrated limited accuracy. The present study aimed to refine the prediction of major amputation in diabetic hindfoot ulcers by 1) identifying additional risk factors and 2) evaluating amputation rates according to these factors.Methods
A retrospective analysis was conducted involving 1,663 hospitalized patients diagnosed with diabetic foot ulcers. From this group, 50 patients with hindfoot ulcers presenting with critical ischemia and infection were included. A total of 88 baseline clinical and laboratory parameters were evaluated to determine key risk factors.Results
Chronic kidney disease (CKD) ≥ stage 3, hemoglobin < 10.35 g/dL, and albumin < 3.75 g/dL emerged as independent predictors of major amputation (P < 0.05). Univariable logistic regression demonstrated a strong positive correlation between the number of identified risk factors and the rate of major amputation. Patients without these three risk factors did not undergo major amputation, even in the presence of critical infection and ischemia. Conversely, amputation risk increased to 6% for individuals with one risk factor, 27% for those with two, and 67% for patients with all three (P < 0.001).Conclusion
CKD, low serum hemoglobin, and low serum albumin were identified as significant risk factors for major amputation in patients with diabetic hindfoot ulcers complicated by critical infection and ischemia. The risk of major amputation increases substantially with the presence of multiple risk factors, from 6% amputation rate with one factor to 67% with three factors. Nevertheless, prospective studies with larger sample sizes are warranted to validate this risk-factor model.
Related
- Plasma albumin and the risk of amputation and mortality in patients hospitalised with diabetic foot ulcers: a Danish nationwide register-based cohort study
- Major re-amputation after initial diabetic foot amputation : A retrospective cohort study
- Association between thyroid feedback quantile-based index and the risk of in-hospital amputation in patients with diabetic foot ulcer.
- Beyond Inflammatory Ratios: Age and CRP as Key Predictors of Re-Amputation in Diabetic Foot Patients
- Predictive Value of Preoperative Inflammatory and Nutritional Indices for Revision Surgery After Major Lower Extremity Amputation in Patients With Wagner Stage 5 Diabetic Foot.
BibTeX
@article{lee2026predicting,
title = {{Predicting Major Amputation Rates in Diabetic Hindfoot Ulcers With Critical Infection and Ischemia: A Risk-Factor-Based Model.}},
author = {Kyu-Il Lee and Woo-Sung Kim and Seung-Kyu Han and Kyung-Chul Moon and Sik Namgoong and Seong-Ho Jeong and Eun-Sang Dhong},
journal = {Journal of Korean medical science},
year = {2026},
month = oct,
doi = {10.3346/jkms.2026.41.e247},
url = {https://europepmc.org/article/MED/42901493},
note = {CC BY-NC},
}
RIS
TY - JOUR
TI - Predicting Major Amputation Rates in Diabetic Hindfoot Ulcers With Critical Infection and Ischemia: A Risk-Factor-Based Model.
AU - Kyu-Il Lee
AU - Woo-Sung Kim
AU - Seung-Kyu Han
AU - Kyung-Chul Moon
AU - Sik Namgoong
AU - Seong-Ho Jeong
AU - Eun-Sang Dhong
PY - 2026
DA - 2026/10/19
JO - Journal of Korean medical science
DO - 10.3346/jkms.2026.41.e247
UR - https://europepmc.org/article/MED/42901493
AB - Background Diabetic hindfoot ulcers pose a substantially greater risk of progressing to major amputation than forefoot or midfoot ulcers. Patients with these ulcers often experience severe psychological distress at the prospect of major limb loss. Consequently, patients, their families, and healthcare professionals prioritize understanding the actual risk of major amputation based on the patient's current clinical status. However, practical tools addressing this critical and common concern remain limited. In a previous preliminary study, we proposed a model for predicting major amputation rates in diabetic hindfoot ulcers. Nonetheless, that model, which relied solely on ischemia and infection, demonstrated limited accuracy. The present study aimed to refine the prediction of major amputation in diabetic hindfoot ulcers by 1) identifying additional risk factors and 2) evaluating amputation rates according to these factors.Methods A retrospective analysis was conducted involving 1,663 hospitalized patients diagnosed with diabetic foot ulcers. From this group, 50 patients with hindfoot ulcers presenting with critical ischemia and infection were included. A total of 88 baseline clinical and laboratory parameters were evaluated to determine key risk factors.Results Chronic kidney disease (CKD) ≥ stage 3, hemoglobin < 10.35 g/dL, and albumin < 3.75 g/dL emerged as independent predictors of major amputation (P < 0.05). Univariable logistic regression demonstrated a strong positive correlation between the number of identified risk factors and the rate of major amputation. Patients without these three risk factors did not undergo major amputation, even in the presence of critical infection and ischemia. Conversely, amputation risk increased to 6% for individuals with one risk factor, 27% for those with two, and 67% for patients with all three (P < 0.001).Conclusion CKD, low serum hemoglobin, and low serum albumin were identified as significant risk factors for major amputation in patients with diabetic hindfoot ulcers complicated by critical infection and ischemia. The risk of major amputation increases substantially with the presence of multiple risk factors, from 6% amputation rate with one factor to 67% with three factors. Nevertheless, prospective studies with larger sample sizes are warranted to validate this risk-factor model.
SN - 1598-6357
ER -