THE KIDNEY'S FATAL SIGNAL: HOW RENAL IMPAIRMENT DICTATES MORTALITY IN HOSPITALIZED DIABETIC FOOT INFECTIONS PATIENTS, A SINGLE-CENTER STUDY FROM YOGYAKARTA, INDONESIA

 

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THE KIDNEY'S FATAL SIGNAL: HOW RENAL IMPAIRMENT DICTATES MORTALITY IN HOSPITALIZED DIABETIC FOOT INFECTIONS PATIENTS, A SINGLE-CENTER STUDY FROM YOGYAKARTA, INDONESIA

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Fariz
Nurul Huda
Fariz Nurul Huda fariznhuda@gmail.com University of Gadjah Mada Internal Medicine Yogyakarta Indonesia *
Rizka Humardewayanti Asdie rizka_asdie@yahoo.com Faculty of Medicine, Public Health and Nursing, Gadjah Mada University/Dr. Sardjito Hospital, Yogyakarta, Indonesia Tropical Medicine and Infectious Diseases, Department of Internal Medicine Yogyakarta Indonesia -
Hemi Sinorita hemisinorita66@gmail.com Faculty of Medicine, Public Health and Nursing, Gadjah Mada University/Dr. Sardjito Hospital, Yogyakarta, Indonesia Division of Endocrinology and Metabolic, Department of Internal Medicine Yogyakarta Indonesia -
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Diabetic Foot Infections (DFI) present a significant mortality risk, a threat severely compounded by the presence of comorbidities. This study sought to identify renal impairment and other independent risk factors for mortality among DFI patients admitted to Dr. Sardjito Hospital in Yogyakarta, Indonesia. The ultimate goal is to facilitate more effective risk stratification and preventive measures for this high-risk patient population.

Data for this observational, cross-sectional study were collected from 200 DFI patients admitted to Dr. Sardjito Central General Hospital, Yogyakarta, Indonesia, from January to December 2023 (via the emergency department or outpatient clinic). To determine the association between potential risk factors and mortality, both bivariate and multivariate logistic regression were conducted. The factors identified as independent predictors in the multivariate analysis formed the basis for developing a mortality prediction model. This model utilized a scoring system derived from the negative exponential function of y. The discriminatory ability of the resulting model was assessed by calculating the Area Under the Curve (AUC) from Receiver Operating Characteristic (ROC) analysis, alongside reporting its sensitivity and specificity.

A total of 31 patients (15.5%) had deceased, while 169 patients (84.5%) showed improvement by the end of the treatment. Multivariate analysis identified four independent variables significantly associated with mortality in DFI: (1) absence of surgical intervention (p 0.016, OR 5.228, 95% CI 1.357-20.140), (2) IWGDF/IDSA grade 4/severe (p <0.001, OR 28.073, 95% CI 7.627-103.334), (3) eGFR < 60 ml/min/1.73 m² (p 0.011, OR 4.386, 95% CI 1.394-13.800), and (4) platelet count < 150 x 10³ cells/µL (p 0.016, OR 6.552, 95% CI 1.425-30.129). The mortality prediction model achieved a maximum score of 5, indicating a mortality risk of 99.45% with a sensitivity of 64.52%, specificity of 95.86%, LR+ of 15.58, and LR- of 0.37. 

Four factors were independently identified as significant risk factors for mortality in DFI: the absence of surgical intervention, IWGDF/IDSA grade 4/severe, eGFR < 60 ml/min/1.73 m², and platelet count <150 x 10³ cells/µL. Renal insufficiency represents a critical prognostic factor and, importantly, a domain for risk stratification and targeted intervention in this vulnerable patient group.

Kewords