Acceso usuarios
Montserrat Doria, Jordi Viade Julia, Elisabet Palomera Fanegas, Ricard Pérez, Melcior Lladó Vidal, Elisabet Costa Company, Teresa Huguet, Jordi L. Reverter Calatayud, Mateu Serra Prat, Josep Franch Nadal, Didac Mauricio Puente
Objetivos Determinar las características clínicas de pacientes con neuroartropatía de Charcot (NC) en España e identificar predictores de complicaciones relacionadas.
Materiales y métodos Estudio retrospectivo llevado a cabo en 5 hospitales terciarios de España con unidad de pie diabético. Se recopilaron datos de 83 pacientes incluyendo perfil demográfico, datos provenientes de la exploración podológica, características de la diabetes y presencia de comorbilidad micro y macro vascular. Para determinar los predictores significativos de acontecimientos clínicos predefinidos se utilizaron análisis de regresión logística.
Resultados Casi todos los pacientes (98,9%) tenían signos de neuropatía diabética en la evaluación inicial, aproximadamente la mitad tenían retinopatía o nefropatía diabética (61,5 y 51,8%, respectivamente) y la enfermedad arterial periférica era infrecuente (8,6%). Treinta y ocho pacientes (47,5%) experimentaron uno o más acontecimientos clínicos relevantes: 22 (27,5%) una nueva úlcera en el pie, 7 (8,7%) una amputación mayor, 20 (25%) fueron hospitalizados y 4 (5%) murieron. Solamente la presencia de nefropatía diabética se encontró independientemente asociada al desarrollo de alguna de las complicaciones estudiadas (p = 0,009; odds ratio = 3,37; 95% CI: 1,12-10,1).
Conclusiones Casi la mitad de los pacientes con NC atendidos en unidades de cuidado del pie diabético en hospitales terciarios experimentaron complicaciones asociadas a NC a corto plazo, y el riesgo entre aquellos sujetos con historia de úlcera previa era 3 veces mayor.
Objectives To assess the clinical characteristics of patients with Charcot neuroarthropathy (CN) in Spain and to identify predictors for CN-related complications.
Patients and methods A retrospective study was conducted at five tertiary hospitals with diabetic foot care units in Spain. Data were collected from 83 patients, including demographic profiles, foot factors, diabetes characteristics, and presence of microvascular and macrovascular comorbidity, and a podiatric examination was also performed. Logistic regression analyses were used to determine significant predictors of the predefined clinical events.
Results Signs of diabetic neuropathy were found in almost all patients (98.9%) at the initial assessment, approximately half of them had diabetic retinopathy or nephropathy (61.5% and 51.8%, respectively), and peripheral artery disease was uncommon (8.6%). Thirty-eight patients (47.5%) experienced one or more relevant clinical events: 22 (27.5%) a new foot ulcer; 7 (8.7%) a major amputation; 20 (25%) were admitted to hospital; and 4 (5%) died. Only the presence of diabetic nephropathy was independently associated to development of any of the complications studied (p = 0.009; odds ratio = 3.37; 95% CI: 1.12-10.1).
Conclusions Almost half the patients with CN attending specialised foot care units in tertiary hospitals experienced short-term CN-associated complications, and the risk was 3 times higher in those with a history of diabetic nephropathy.
