Prognostic value of the site, depth, and infection/ischemia classification system in diabetic foot ulcers: a retrospective cohort study
Abstract Diabetic foot ulcers (DFUs) represent a significant challenge in diabetic care, with variable prognoses influenced by factors such as ulcer location, depth, and the presence of infection or ischemia. The Site, Depth, and Infection/Ischemia (SDI) classification system is a potential tool for...
Saved in:
| Main Authors: | , , , , , , , |
|---|---|
| Format: | Article |
| Language: | English |
| Published: |
Nature Portfolio
2025-07-01
|
| Series: | Scientific Reports |
| Subjects: | |
| Online Access: | https://doi.org/10.1038/s41598-025-06509-5 |
| Tags: |
Add Tag
No Tags, Be the first to tag this record!
|
| _version_ | 1849342378966515712 |
|---|---|
| author | Chun-Hua Zhang Chun-Yan Jiao Li Li Chen-Hui Sui Ting Ji Fan Wang Jin-Jun Wang Xiao-Na Liu |
| author_facet | Chun-Hua Zhang Chun-Yan Jiao Li Li Chen-Hui Sui Ting Ji Fan Wang Jin-Jun Wang Xiao-Na Liu |
| author_sort | Chun-Hua Zhang |
| collection | DOAJ |
| description | Abstract Diabetic foot ulcers (DFUs) represent a significant challenge in diabetic care, with variable prognoses influenced by factors such as ulcer location, depth, and the presence of infection or ischemia. The Site, Depth, and Infection/Ischemia (SDI) classification system is a potential tool for predicting DFU outcomes, but its prognostic value requires further investigation. This retrospective cohort study, conducted at Qingdao Haici Hospital between January 2021 and December 2022, included 261 diabetic patients with DFUs located at or distal to the ankle joint. The SDI classification system was applied to categorize ulcers based on site, depth, and infection/ischemia. Patient outcomes, including healing time, minor and major amputations, and mortality, were assessed, with follow-up conducted through telephone or outpatient visits. Statistical analysis was performed using SPSS version 27, with p-values < 0.05 considered statistically significant. The study included 240 patients after exclusions. Significant differences in healing time, amputation rates, and mortality were observed across different SDI classifications. Patients with hindfoot ulcers (S3) had the longest healing time (9.3 months) and the highest mortality (23.1%). Deeper ulcers (D3) also exhibited longer healing times (4.3 months) and higher mortality (18.5%). Patients with both infection and ischemia (I3) had the longest healing time (5.6 months), highest amputation rates, and increased mortality. Statistical analyses revealed significant differences in healing time (p < 0.001), amputation rates (p = 0.000), and mortality (p = 0.017) across classification groups. The SDI classification system effectively predicts outcomes in DFU patients, with higher SDI grades associated with longer healing times, higher amputation rates, and increased mortality. This study highlights the clinical utility of the SDI system and underscores the need for its further implementation in clinical practice for better patient management and prognostic assessment. |
| format | Article |
| id | doaj-art-3a9f2d7d17e44a6193b8f117b95a81b0 |
| institution | Kabale University |
| issn | 2045-2322 |
| language | English |
| publishDate | 2025-07-01 |
| publisher | Nature Portfolio |
| record_format | Article |
| series | Scientific Reports |
| spelling | doaj-art-3a9f2d7d17e44a6193b8f117b95a81b02025-08-20T03:43:26ZengNature PortfolioScientific Reports2045-23222025-07-011511910.1038/s41598-025-06509-5Prognostic value of the site, depth, and infection/ischemia classification system in diabetic foot ulcers: a retrospective cohort studyChun-Hua Zhang0Chun-Yan Jiao1Li Li2Chen-Hui Sui3Ting Ji4Fan Wang5Jin-Jun Wang6Xiao-Na Liu7Department of Wound Repair, Rizhao People’s HospitalDepartment of Wound Repair, Rizhao People’s HospitalDepartment of Wound Repair, Rizhao People’s HospitalHealth Service Center, Shuqinggou Sub-district Community Health CenterDepartment of Vascular Surgery, Qingdao Hiser Hospital Affiliated of Qingdao UniversityDepartment of Vascular Surgery, Qingdao Hiser Hospital Affiliated of Qingdao UniversityDepartment of Vascular Surgery, Qingdao Hiser Hospital Affiliated of Qingdao UniversityDepartment of Vascular Surgery, Qingdao Hiser Hospital Affiliated of Qingdao UniversityAbstract Diabetic foot ulcers (DFUs) represent a significant challenge in diabetic care, with variable prognoses influenced by factors such as ulcer location, depth, and the presence of infection or ischemia. The Site, Depth, and Infection/Ischemia (SDI) classification system is a potential tool for predicting DFU outcomes, but its prognostic value requires further investigation. This retrospective cohort study, conducted at Qingdao Haici Hospital between January 2021 and December 2022, included 261 diabetic patients with DFUs located at or distal to the ankle joint. The SDI classification system was applied to categorize ulcers based on site, depth, and infection/ischemia. Patient outcomes, including healing time, minor and major amputations, and mortality, were assessed, with follow-up conducted through telephone or outpatient visits. Statistical analysis was performed using SPSS version 27, with p-values < 0.05 considered statistically significant. The study included 240 patients after exclusions. Significant differences in healing time, amputation rates, and mortality were observed across different SDI classifications. Patients with hindfoot ulcers (S3) had the longest healing time (9.3 months) and the highest mortality (23.1%). Deeper ulcers (D3) also exhibited longer healing times (4.3 months) and higher mortality (18.5%). Patients with both infection and ischemia (I3) had the longest healing time (5.6 months), highest amputation rates, and increased mortality. Statistical analyses revealed significant differences in healing time (p < 0.001), amputation rates (p = 0.000), and mortality (p = 0.017) across classification groups. The SDI classification system effectively predicts outcomes in DFU patients, with higher SDI grades associated with longer healing times, higher amputation rates, and increased mortality. This study highlights the clinical utility of the SDI system and underscores the need for its further implementation in clinical practice for better patient management and prognostic assessment.https://doi.org/10.1038/s41598-025-06509-5Diabetic foot ulcersSDI classificationHealing timeAmputationInfectionIschemia |
| spellingShingle | Chun-Hua Zhang Chun-Yan Jiao Li Li Chen-Hui Sui Ting Ji Fan Wang Jin-Jun Wang Xiao-Na Liu Prognostic value of the site, depth, and infection/ischemia classification system in diabetic foot ulcers: a retrospective cohort study Scientific Reports Diabetic foot ulcers SDI classification Healing time Amputation Infection Ischemia |
| title | Prognostic value of the site, depth, and infection/ischemia classification system in diabetic foot ulcers: a retrospective cohort study |
| title_full | Prognostic value of the site, depth, and infection/ischemia classification system in diabetic foot ulcers: a retrospective cohort study |
| title_fullStr | Prognostic value of the site, depth, and infection/ischemia classification system in diabetic foot ulcers: a retrospective cohort study |
| title_full_unstemmed | Prognostic value of the site, depth, and infection/ischemia classification system in diabetic foot ulcers: a retrospective cohort study |
| title_short | Prognostic value of the site, depth, and infection/ischemia classification system in diabetic foot ulcers: a retrospective cohort study |
| title_sort | prognostic value of the site depth and infection ischemia classification system in diabetic foot ulcers a retrospective cohort study |
| topic | Diabetic foot ulcers SDI classification Healing time Amputation Infection Ischemia |
| url | https://doi.org/10.1038/s41598-025-06509-5 |
| work_keys_str_mv | AT chunhuazhang prognosticvalueofthesitedepthandinfectionischemiaclassificationsystemindiabeticfootulcersaretrospectivecohortstudy AT chunyanjiao prognosticvalueofthesitedepthandinfectionischemiaclassificationsystemindiabeticfootulcersaretrospectivecohortstudy AT lili prognosticvalueofthesitedepthandinfectionischemiaclassificationsystemindiabeticfootulcersaretrospectivecohortstudy AT chenhuisui prognosticvalueofthesitedepthandinfectionischemiaclassificationsystemindiabeticfootulcersaretrospectivecohortstudy AT tingji prognosticvalueofthesitedepthandinfectionischemiaclassificationsystemindiabeticfootulcersaretrospectivecohortstudy AT fanwang prognosticvalueofthesitedepthandinfectionischemiaclassificationsystemindiabeticfootulcersaretrospectivecohortstudy AT jinjunwang prognosticvalueofthesitedepthandinfectionischemiaclassificationsystemindiabeticfootulcersaretrospectivecohortstudy AT xiaonaliu prognosticvalueofthesitedepthandinfectionischemiaclassificationsystemindiabeticfootulcersaretrospectivecohortstudy |