Outcome Predictors for Wound Healing and Amputation Risk in Patients with Diabetic Foot Ulcer

Background: Diabetic foot ulcers (DFUs) are a common and serious complication of diabetes mellitus, often leading to delayed wound healing, infection, and lower limb amputation. Identifying key predictors of poor outcomes is crucial for effective clinical management.  Objectives: To identify and evaluate key clinical, chemical, and biochemical predictors—particularly ulcer size, HbA1c, and infection status—that influence wound healing outcomes and the risk of amputation in patients with diabetic foot ulcers, in order to guide early intervention and improve patient management.  Methods: A prospective observational study was conducted on 51 inpatients with DFUs at Government Cuddalore Medical College and Hospital over a three-month period. Patient demographics, ulcer characteristics, comorbidities, glycemic control (HbA1c), and infection status were recorded. Statistical analysis included Cox regression and ROC curve analysis to identify independent predictors of healing and amputation risk.  Results: The mean age of this study was 58.2 years, with a mean HbA1c of 8.8% and average ulcer size of 4.7 cm2. In multivariate Cox regression, ulcer size (HR 0.89, p=0.038), HbA1c (HR 0.82, p=0.014), and infection status (HR 0.65, p=0.017) were identified as independent predictors of delayed healing. ROC analysis showed ulcer size had the highest predictive value for both wound healing (AUC 0.81) and amputation risk (AUC 0.86), while HbA1c and ABI demonstrated moderate predictive ability.  Conclusion: Ulcer size is the strongest independent predictor of poor wound healing and amputation risk in DFU patients. Early recognition and aggressive management of larger ulcers, along with infection control and glycemic optimization, are critical to improving patient outcomes and reducing complications.