Frailty associated wound outcomes in patients with diabetic foot ulcers (DFUs) - A cohort pilot study

Objective: Managing patients with diabetic foot ulcer (DFU) requires close monitoring and regular clinic visits. Diabetes in older adults may coexist with frailty1, a geriatric syndrome of decreased physiologic reserve that have been hypothesized to impact the proinflamatory state of wounds2,3. Together, these conditions can lead to lack of compliance4, increasing the risk of infection and/or tissue loss; consequently, delaying the wound healing process5.

This study aims to elucidate the association of frailty and wound outcomes in patients with DFU.

Methods: A single-center, cohort study of patients with DFU was performed. Using a validated trauma-specific frailty index (TSFI) questionnaire, patients with a score of >0.27 were classified as frail; all others as non-frail. Primary outcome was wound area measured with a 3D camera. Secondary outcomes included oxygen values (skin perfusion pressure, SPP; total tissue hemoglobin, TTHb), and cognitive associated frailty index (CAF), measured with a SPP test, near infrared spectroscopy, and an upper extremity frailty meter test, respectively. Associations between frailty and wound outcomes were also explored. Results: 38 patients (n=16 frail; n=22 non-frail) with DFU were recruited (Age=61.3±2.8yrs, p=0.76, d=0.11; BMI=31±1.7 kg/m2, p=0.44, d=0.25; male=68%, p=0.4, Cramer’s V=0.12; previous revascularization=41%, p=0.65, d=0.15). The frail group showed a trend for larger wound area (12.15±11.52 vs. 5.72±8.86 cm2. p=0.06) compared to the non-frail group. Moreover, frails exhibited significant lower SPP (64.2 vs. 82.05mmHg, p=0.01) and TTHb (0.63 vs. 0.75a.u., p=0.04) compared to the non-frails. CAF was also significantly higher in frail patients (0.32 vs.0.24 a.u., P< 0.01). Moreover, significant correlations of TSFI and CAF scores with wound area (r=0.406, p=0.012, r=0.33, p=0.03, respectively), and SPP (r=-0.451, p=0.009, r=-0.48, p=0.003, respectively) were found.

Conclusion: Frailty status may have an indication for wound severity or healing progress in DFU. These observations should be validated in a larger sample size.