PMID- 35450383
OWN - NLM
STAT- MEDLINE
DCOM- 20220425
LR  - 20221207
IS  - 2314-6753 (Electronic)
IS  - 2314-6745 (Print)
VI  - 2022
DP  - 2022
TI  - Factors Influencing the Risk of Major Amputation in Patients with Diabetic Foot 
      Ulcers Treated by Autologous Cell Therapy.
PG  - 3954740
LID - 10.1155/2022/3954740 [doi]
LID - 3954740
AB  - INTRODUCTION: Autologous cell therapy (ACT) is one of the last options for limb 
      salvage in patients with chronic limb-threatening ischemia (CLTI) and diabetic 
      foot ulcers (DFU). However, some patients may still undergo a major amputation 
      even after ACT, but the risk factors for this are not known. Therefore, the aim 
      of our study was to assess the risk factors for major amputation in patients with 
      CLTI and DFU during a 2-year follow-up after ACT. METHODS: One hundred and 
      thirteen patients after ACT were included in our study and divided into two 
      groups: Group 1 with major amputation (AMP; n = 37) and Group 2 without 
      amputation (nAMP, n = 76). The risk factors for major amputation were evaluated 
      before ACT and included factors relating to the patient, the DFU, and the cell 
      product. RESULTS: The AMP group had significantly higher C-reactive protein (CRP) 
      levels compared to the nAMP group (22.7 vs. 10.7 mg/L, p = 0.024). In stepwise 
      logistic regression, independent predictors for major amputation were mutation of 
      the gene for methylenetetrahydrofolate reductase (MTHFR) with heterozygote and 
      homozygote polymorphism 1298 (OR 4.33 [95% CI 1.05-17.6]), smoking (OR 3.83 [95% 
      CI 1.18-12.5]), and CRP > 10 mg/L (OR 2.76 [95% CI 0.93-8.21]). Lower 
      transcutaneous oxygen pressure (TcPO(2)) values were observed in AMP patients 
      compared to the nAMP group at one month (24.5 vs. 33.2, p = 0.012) and at 3 
      months (31.1 vs. 40.9, p = 0.009) after ACT. CONCLUSION: Our study showed that 
      the risk for major amputation after ACT in patients with CLTI and DFU is 
      increased by the presence of MTHFR heterozygote and homozygote gene mutations, 
      smoking, and higher CRP at baseline. Lower TcPO(2) at one and 3 months after ACT 
      may also have a predictive value. Therefore, it is necessary to stop smoking 
      before ACT, treat any infection, and, above all, consider antiaggregation or 
      anticoagulant treatment after the procedure.
CI  - Copyright (c) 2022 J. Husakova et al.
FAU - Husakova, J
AU  - Husakova J
AUID- ORCID: 0000-0002-6073-655X
AD  - Diabetes Centre, Institute for Clinical and Experimental Medicine, Prague, Czech 
      Republic.
AD  - First Faculty of Medicine, Charles University, Prague, Czech Republic.
FAU - Bem, R
AU  - Bem R
AUID- ORCID: 0000-0003-4127-1846
AD  - Diabetes Centre, Institute for Clinical and Experimental Medicine, Prague, Czech 
      Republic.
FAU - Fejfarova, V
AU  - Fejfarova V
AUID- ORCID: 0000-0003-4486-5383
AD  - Diabetes Centre, Institute for Clinical and Experimental Medicine, Prague, Czech 
      Republic.
AD  - First Faculty of Medicine, Charles University, Prague, Czech Republic.
AD  - Second Faculty of Medicine, Charles Unviersity, Prague, Czech Republic.
FAU - Jirkovska, A
AU  - Jirkovska A
AUID- ORCID: 0000-0002-3622-997X
AD  - Diabetes Centre, Institute for Clinical and Experimental Medicine, Prague, Czech 
      Republic.
FAU - Woskova, V
AU  - Woskova V
AD  - Diabetes Centre, Institute for Clinical and Experimental Medicine, Prague, Czech 
      Republic.
FAU - Jarosikova, R
AU  - Jarosikova R
AD  - Diabetes Centre, Institute for Clinical and Experimental Medicine, Prague, Czech 
      Republic.
AD  - First Faculty of Medicine, Charles University, Prague, Czech Republic.
FAU - Lovasova, V
AU  - Lovasova V
AUID- ORCID: 0000-0003-2659-7725
AD  - First Faculty of Medicine, Charles University, Prague, Czech Republic.
AD  - Transplant Surgery Department, Institute for Clinical and Experimental Medicine, 
      Prague, Czech Republic.
FAU - Jude, E B
AU  - Jude EB
AUID- ORCID: 0000-0002-3186-4122
AD  - Diabetes Center, Tameside and Glossop Integrated Care NHS Foundation Trust and 
      University of Manchester, Lancashire, UK.
FAU - Dubsky, M
AU  - Dubsky M
AUID- ORCID: 0000-0002-2078-0177
AD  - Diabetes Centre, Institute for Clinical and Experimental Medicine, Prague, Czech 
      Republic.
AD  - First Faculty of Medicine, Charles University, Prague, Czech Republic.
LA  - eng
PT  - Journal Article
DEP - 20220411
PL  - England
TA  - J Diabetes Res
JT  - Journal of diabetes research
JID - 101605237
RN  - 415SHH325A (Adenosine Monophosphate)
SB  - IM
MH  - Adenosine Monophosphate
MH  - Amputation, Surgical
MH  - Cell- and Tissue-Based Therapy
MH  - Chronic Limb-Threatening Ischemia
MH  - *Diabetes Mellitus
MH  - *Diabetic Foot/surgery
MH  - Humans
MH  - Ischemia/surgery
MH  - Limb Salvage
MH  - Retrospective Studies
MH  - Risk Factors
MH  - Treatment Outcome
MH  - Wound Healing
PMC - PMC9017448
COIS- No potential conflicts of interest relevant to this article were reported.
EDAT- 2022/04/23 06:00
MHDA- 2022/04/26 06:00
PMCR- 2022/04/11
CRDT- 2022/04/22 06:41
PHST- 2021/10/01 00:00 [received]
PHST- 2022/02/15 00:00 [revised]
PHST- 2022/03/19 00:00 [accepted]
PHST- 2022/04/22 06:41 [entrez]
PHST- 2022/04/23 06:00 [pubmed]
PHST- 2022/04/26 06:00 [medline]
PHST- 2022/04/11 00:00 [pmc-release]
AID - 10.1155/2022/3954740 [doi]
PST - epublish
SO  - J Diabetes Res. 2022 Apr 11;2022:3954740. doi: 10.1155/2022/3954740. eCollection 
      2022.