Clinical research on predicting the outcome of amputation of diabetic arterial occlusion by WIFi classification after endovascular therapy

Objective To evaluate the clinical significance of wound-ischemia-foot infection (WIFi) classification in predicting the occurrence of amputation after endovascular therapy in patients with diabetic arterial occlusion (DAO). Methods Eighty patients with DAO in Shandong Provincial Hospital, Jinan Municiple Hospital of Traditional Chinese Medicine and Zhanhua District People’s Hospital from July 2015 to July 2018 were divided into two groups according to be amputated or not. Forty-four patients were included in the amputation group while 36 patients in the non-amputation group. The clinical data and WIFi grading after endovascular therapy were analyzed retrospectively. The independent risk factors of amputation in DAO patients were analyzed by Logistic regression. Results There were no significant differences in sex (χ2=1.678, P=0.195), age (t=1.697, P=0.094), glycosylated hemoglobin (t=-0.419, P=0.677), body mass index (t=-0.236, P=0.814), fasting blood glucose (t=-0.640, P=0.524), duration of diabetes mellitus (t=-0.732, P=0.466) and history of hypertension (χ2=1.347, P=0.466) between the two groups. The number of high-grade patients with woud (W), ischemia (I) and foot infection (Fi) in the amputation group was significantly higher than that in the non-amputation group (χ2=27.963, 30.901, 19.140, all P<0.001). Logistic regression showed that W, I and Fi were independent risk factors for amputation in patients with DAO after intracavitary treatment (95% CI: 0.022-0.309, 0.020-0.319, 0.073-0.900, P<0.001, <0.001, 0.034). Conclusions The degree of lower limb ischemia, wound or gangrene of lower limb and foot infection are independent risk factors for amputation after intracavitary treatment of DAO. WIFi grade can effectively predict amputation after endovascular therapy of DAO. Key words: Diabetes mellitus; Arterial occlusive diseases; Amputation; Risk factors; WIFi classification