The amputation and mortality rates of diabetic patients with critical limb ischemia: A nationwide population-based follow-up study in Taiwan

Purpose: To describe the epidemiological profiles and the amputation and mortality rates of diabetic patients in Taiwan with critical limb ischemia. Materials and methods: Data were collected from the Longitudinal Health Insurance Database 2000 (LHID2000), a database composed of one million randomly selected beneficiaries in Taiwan. To measure major amputation and mortality, diabetic patients with critical limb ischemia (CLI) were identified by specific ICD-9-CM diagnostic, procedure, and order codes. The patients were traced until the end of 2009. Cox proportional hazard regressions were used to determine the crude and adjusted hazard ratios for the risk factors for amputation and mortality during the follow-up period. Results: We identified 6418 diabetic patients with CLI from the LHID database during 1997e2006. Of these patients, 256 (3.99%) patients underwent surgical revascularization and 6418 (96.01%) patients received conservative treatment only. The revascularization cohort had more comorbidities than the surgical group (e.g., cardiovascular, 13.28% vs. 8.62%, respectively, p Z 0.0099; renal, 23.05% vs. 5.34%, respectively, p < 0.0001). The amputation and mortality rates for diabetic CLI patients in Taiwan were 5.75% and 18.62%, respectively. Male gender, an age of greater than 50 years old, and cardiovascular and renal comorbidities were identified as risk factors for amputation. The risk factors for mortality also included old age (i.e., >50 years), male gender, and comorbid cardiovascular, renal, neurological, and pulmonary diseases. Conclusion: Diabetic patients who needed surgical revascularization or who needed conservative treatment for CLI had different comorbid profiles. The common risk factors for amputation and mortality in diabetic CLI patients include male gender, age of > 50 years, and concurrent cardiovascular and renal diseases.