Diabetes and Vascular Disease

SUN-603 - Predictive Value of Ulcer Severity and Local Factors on Mortality in Diabetic Foot Ulcer Patients: A Systematic Review and Meta-Analysis

Sunday, June 14, 2026

9:00 AM - 4:00 PM CT

Location: ENDOExpo; Poster Floor

Co-Author(s)

MF

Muhammad Farhan, MBBS

Ajman University, College of Medicine
Ajman, United Arab Emirates
TP

Tirath Patel, MD

Trinity Medical Sciences University School of Medicine
Kingstown, Saint Vincent and the Grenadines
BP

Bhumi Daishik Patel, AS

Windsor University School of Medicine
Cayon, Saint Kitts and Nevis

Abstract Poster Presenter(s)

NS

Nana Sardarova, MD

Henry Ford health Warren
Warren, Michigan, United States

Co-Author(s)

NS

Nana Sardarova, MD

Henry Ford health Warren
Warren, Michigan, United States

Senior Author/Primary Investigator(s)

JG

John Geisler, MD

Trinity Medical Sciences University School of Medicine
Osbourn, Saint Vincent and the Grenadines

Co-Author(s)

JG

John Geisler, MD

Trinity Medical Sciences University School of Medicine
Osbourn, Saint Vincent and the Grenadines

Senior Author/Primary Investigator(s)

KM

Kelly Manahan, MD

Trinity Medical Sciences University School of Medicine
Osbourn, Saint Vincent and the Grenadines

Co-Author(s)

KM

Kelly Manahan, MD

Trinity Medical Sciences University School of Medicine
Osbourn, Saint Vincent and the Grenadines

Objective:
To quantify the association between ulcer severity classification systems and local pathological factors with all-cause mortality in adults with DFUs.

Methods:
This systematic review and meta-analysis followed PRISMA 2020 guidelines. We searched PubMed, Embase, Scopus, and CENTRAL from inception for observational studies reporting mortality outcomes stratified by DFU severity or infectious factors. Pooled odds ratios (OR) and hazard ratios (HR) were calculated using random-effects models.

Results:
Twenty studies were included. Compromised perfusion (PEDIS grade) and gangrene were the strongest predictors of mortality, associated with a fivefold increase (HR 5.04; 95% CI: 3.11–8.17) and a 71% increase (HR 1.71; 95% CI: 1.59–1.84) in risk, respectively. Advanced ulcer grades were significantly predictive of death, specifically higher Wagner grades (OR 6.61; 95% CI: 3.75–11.64) and higher University of Texas (UT) grades (HR 3.04; 95% CI: 2.10–4.40). A history of amputation was associated with a two-fold increase in mortality odds (OR 2.05), while osteomyelitis alone did not show a statistically significant association.

Conclusions:
Ulcer severity and specific pathological deficits, particularly ischemia and gangrene, are critical prognostic markers for mortality in DFU patients. Clinicians should prioritize these factors for early risk stratification and multidisciplinary management.

*Unless otherwise noted, all abstracts presented at ENDO must not be released to the press or the public until the date and time of presentation. For oral presentations, the abstracts are embargoed until the session begins. The Endocrine Society reserves the right to lift the embargo on specific abstracts that are selected for promotion prior to or during ENDO.*