Evidence map›Paper›PMID 39508881›Full record

ArticleDiabetologia2025

Increased risk of major adverse cardiovascular events in patients with deep and infected diabetes-related foot ulcers.

Nick S R Lan, Jonathan Hiew, Ivana Ferreira, J Carsten Ritter, Laurens Manning, P Gerry Fegan, Girish Dwivedi, Emma J Hamilton

Abstract read
PubMed Full text at PMC Publisher
In one paragraph

Article in Diabetologia, 2025. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 6 papers.

0numbers the graph read from it
0cells of the map it votes in
6citing papers in PubMed
–field-weighted citation impact
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

6 citing papers in PubMed.

  1. Article
  2. Review
  3. Article
  4. Observational
  5. Article
  6. Review
4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

8 authors.

Nick S R LanCentre of Excellence for Cardiometabolic Health, Fiona Stanley Hospital, Perth, Australia.ORCID http://orcid.org/0000-0002-7222-7314
Jonathan HiewCentre of Excellence Multidisciplinary Diabetes Foot Ulcer Service, Fiona Stanley and Fremantle Hospitals Group, Perth, Australia.ORCID http://orcid.org/0000-0002-8109-0778
Ivana FerreiraCentre of Excellence Multidisciplinary Diabetes Foot Ulcer Service, Fiona Stanley and Fremantle Hospitals Group, Perth, Australia.ORCID http://orcid.org/0000-0002-7309-3960
J Carsten RitterCentre of Excellence Multidisciplinary Diabetes Foot Ulcer Service, Fiona Stanley and Fremantle Hospitals Group, Perth, Australia.ORCID http://orcid.org/0000-0001-8818-9079
Laurens ManningMedical School, The University of Western Australia, Perth, Australia.ORCID http://orcid.org/0000-0003-4334-5351
P Gerry FeganMedical School, Curtin University, Perth, Australia.ORCID http://orcid.org/0000-0001-8100-6209
Girish Dwivedi *Centre of Excellence for Cardiometabolic Health, Fiona Stanley Hospital, Perth, Australia. girish.dwivedi@perkins.uwa.edu.au.ORCID http://orcid.org/0000-0003-0717-740X
Emma J Hamilton *Medical School, The University of Western Australia, Perth, Australia. emma.hamilton@uwa.edu.au.ORCID http://orcid.org/0000-0003-1617-6353

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

aims/hypothesisDiabetes-related foot ulceration (DFU) is associated with increased cardiovascular risk, but the mechanisms remain unclear. Inflammation and infection are mediators of CVD, which may be important in DFU.

methodsProspectively collected data from patients attending a multidisciplinary DFU service were analysed. A deep ulcer was defined as one that reached muscle, tendon or deeper structures. Patients were categorised into four DFU groups: not deep and no infection (D-/I-), not deep but infected (D-/I+), deep with no infection (D+/I-) or deep with infection (D+/I+). Incident major adverse cardiovascular events (MACE) were defined as hospitalisation for myocardial infarction, stroke or transient ischaemic attack, or heart failure. Survival analyses were performed using the logrank test and multivariate Cox regression.

resultsOf 513 patients, 241 (47.0%) were in the D-/I- group, 110 (21.4%) were in the D-/I+ group, 35 (6.8%) were in the D+/I- group and 127 (24.8%) were in the D+/I+ group. MACE or all-cause mortality occurred in 75 patients (14.6%), and MACE alone occurred in 46 patients (9.0%) after median follow-up of 381 days (IQR 220-551) and 404 days (IQR 228-576), respectively. Infection was associated with significantly higher MACE or all-cause mortality (21.5% vs 8.7%; p<0.001) and MACE alone (13.5% vs 5.1%; p=0.003). MACE or all-cause mortality was significantly higher in the D+/I+ group (D-/I- 7.9%; D-/I+ 15.5%; D+/I- 14.3%; D+/I+ 26.8%; p<0.001), as was MACE alone (D-/I- 5.0%; D-/I+ 10.9%; D+/I- 5.7%; D+/I+ 15.7%; p=0.017). Infection and a deep ulcer were independent predictors of adverse outcomes. CONCLUSIONS/

interpretationDeep and/or infected DFUs are associated with increased cardiovascular risk compared with DFUs that are not deep or infected. These findings provide a potential mechanistic explanation that requires investigation.

Indexed as

Cardiovascular DiseasesDiabetic FootAgedFemaleHumansMaleMiddle AgedMyocardial InfarctionProspective StudiesRisk FactorsCardiovascular diseasesCoronary artery diseaseDiabetesFoot ulcerMyocardial infarctionRisk factors

Identifiers

PMID39508881
PMCPMC11732954

What Socratic holds

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Registered trials

None linked

Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the Socratic graph.