Objective : The risk for mortality has not been systematically studied in patients with Charcot neuroarthropathy (CN) prospectively. We studied the mortality risk and the predictors of mortality in a cohort of patients with CN in comparison to patients of diabetes without foot complications.
Patients of diabetes with foot complications and another cohort without foot complications from three referral centers were prospectively evaluated till August 2018 or death, whichever was earlier. Data for known risk factors for mortality including the demographic details, duration of diabetes, microvascular and macrovascular complications, foot characteristics, and laboratory parameters were recorded. Primary outcome was defined as time to death or survival till the dataset was freezed after the first presentation with CN. Multistep regression analysis was used to identify the predictors of mortality after adjustment.
A total of 313 patients with CN of foot out of 2789 patients (11.2%) with foot complications were identified. Mean age of patients with CN was 55.83±9.1 years, duration of diabetes 12.9±7.8 years, baseline HbA1C was 8.55 ± 1.9%, eGFR 65.3 ±33.9, 64.2% patients had retinopathy, 49.3% had nephropathy, 8.5% with prevalent coronary artery disease and 4.2% ischemic stroke.
47 patients (15.01%) died during follow up and cardiovascular events (CVE) was the most common reason for mortality (32%) followed by renal events (24.6%), infections (10.2%), hypoglycemia (8.6%), cancer (1.5%) and unknown in 23.1%. Mortality amongst the cohort without foot complications was 9.8% as compared to 15% in those with CN (p=0.03). After adjusting for baseline parameters, odds ratio for death in CN group was 2.72 (95% CI, 1.4-5.2;p=0.003). Multiple regression analysis revealed that prevalent CAD and low eGFR at baseline predicted excess mortality amongst patients with CN.
Patients with CN of foot have an excess mortality risk compared to individuals without foot complications even after adjusting for age, duration of adiabetes and glycemic control.
The data regarding mortality in CN is contrasting. Sohn et al observed 35% excess mortality amongst CN patients compared to those with uninfected DFU and 23% lesser mortality compared to diabetes alone group. However, these studies have no control group or were retrospective. We observed that CVE was the most common reason for demise amongst patients with CN and prevalent coronary (CAD) and low eGFR predicted excess mortality.
Conclusion : Patients with CN have more than two times odds for mortality compared to those patients with diabetes without foot complications. CVE are the most frequent reason for excess mortality.
Deptt. of Endocrinology, PGIMER, Chandigarh
Chandigarh, Chandigarh, India
Faculty at Deptt. of Endocrinology at PGIMER, Chandigarh. Actively involved in patient care and research in the field of Diabetic Foot Complications
Chandigarh, Chandigarh, India
Professor of Endocrinology at PGIMER, Chandigarh