Mortalidad de pacientes internados por pie diabético en un hospital de Costa Rica (2017-2019)

José María Rojas-Bonilla; Yeimi Camacho-Álvarez; Kattia Campos-Zamora; Tania Román-González; Rebeca Alvarado-Prado; Juan José  Romero-Zúñiga

doi:10.19136/hs.a22n2.5293

Authors

José María Rojas-Bonilla Costa Rican Social Security Fund, Costa Rica https://orcid.org/0000-0002-3812-6966
Yeimi Camacho-Álvarez Costa Rican Social Security Fund, Costa Rica. https://orcid.org/0000-0002-3466-9920
Kattia Campos-Zamora Costa Rican Social Security Fund, Costa Rica. https://orcid.org/0000-0003-2398-9328
Tania Román-González Pipasa SRL Corporation https://orcid.org/0000-0002-4401-9972
Rebeca Alvarado-Prado School of Public Health, University of Costa Rica. https://orcid.org/0000-0003-4085-3123
Juan José Romero-Zúñiga National University, Costa Rica https://orcid.org/0000-0002-5252-1604

DOI:

https://doi.org/10.19136/hs.a22n2.5293

Abstract

Objective: To identify clinical and sociodemographic factors associated with mortality in patients hospitalized for diabetic foot, in the Diabetic Foot Unit of the San Juan de Dios Hospital in Costa Rica, from 2017 to 2019.

Materials and methods: A retrospective cohort study with 238 patients, followed from hospitalization until death or until December 31, 2021, still alive. A descriptive analysis is made of the sociodemographic, clinical, and cause of death variables. A Cox proportional hazards model is run for all causes of death, and another exclusively for death from cardiovascular causes. Survival times are analyzed using Kaplan-Meier curves, with the log-rank test for comparison.

Results: Most of the deceased were men, did not have a partner, lived in urban or predominantly urban areas, were 15 years or older, diabetic, hypertensive, with peripheral arterial disease, anemia, inadequate glycosylated hemoglobin, and obesity. The mortality rate was 23,53%, and cardiovascular disease was the main cause of death (35,70%). The variables associated with all-cause mortality, adjusted for age and sex were: absence of a partner (HR: 13,09; 95% CI: 4,04-42,31), obesity (HR: 2,89; 95% CI %: 1,59-5,27), peripheral arterial disease (HR: 2,26; CI 95%: 1,25-4,09), years of evolution of diabetes mellitus ≥ 15 years (HR: 1,99; CI 95 %: 1,04-3,82). In turn, for cardiovascular mortality were: obesity (HR: 6,42; 95% CI: 2,07-19,87), peripheral arterial disease (HR: 3,88; 95% CI: 1,39-10,79) and heart disease (HR: 4,11; 95% CI: 1,62-10,46).

Conclusions: Evolution of diabetes mellitus greater than or equal to 15 years, not having a partner, obesity and peripheral arterial disease were associated with all-cause mortality. Regarding death from cardiovascular disease, the associated variables were obesity, peripheral arterial disease, and heart disease.

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Author Biographies

José María Rojas-Bonilla, Costa Rican Social Security Fund, Costa Rica

Bachelor of Medicine and Surgery from the Autonomous University of Central America (2016). Diabetic Foot Unit Physician, San Juan de Dios Hospital. San José, Costa Rica from 2016 to date.
Yeimi Camacho-Álvarez, Costa Rican Social Security Fund, Costa Rica.

Master in Nursing, Nursing Management (2014). Santa Barbara Health Area. Costa Rican social security box. Heredia, Costa Rica since 2009 and present year.
Kattia Campos-Zamora, Costa Rican Social Security Fund, Costa Rica.

Master in Nursing, Public Health with Emphasis in Epidemiology. Santo Domingo Health Area. Costa Rican social security box. Heredia, Costa Rica from 2003 to the present.
Tania Román-González, Pipasa SRL Corporation

Degree in Veterinary Medicine from the National University, Costa Rica (1987). Bachelor of Business Administration from the International University of the Americas (1990). Leadership in Food Safety from the University of Minnesota, ITCA and PAHO (2011). Management of the sanitary part of the flocks 2014 to present.
Rebeca Alvarado-Prado, School of Public Health, University of Costa Rica.

Professional in health promotion with a master's degree in epidemiology. Professor and researcher at the School of Public Health of the University of Costa Rica and the National University.
Juan José Romero-Zúñiga, National University, Costa Rica

Veterinary Doctor from the National University, Costa Rica (1996). MSc in Sustainable Animal Reproduction from the National University, Costa Rica (1998). PhD in Epidemiology from Wageningen University and Research, The Netherlands (2005). Professor at the School of Veterinary Medicine of the National University, Costa Rica, from 2001 to date. Coordinator and professor of the Master's Degree in Epidemiology, National University, Costa Rica, from 2002 to 2021.