Introduction and Objective: There is a need to identify additional tools to enhance risk stratification of people with Diabetic Foot Ulcers (DFU). This study aimed to evaluate the potential of material debrided from DFU to predict ulcer outcome. Methods: Fifty-three consecutively presenting patients with DFU were recruited and underwent conventional DFU treatment including debridement, where appropriate. Debrided material was collected, processed, and examined histologically. Patients were categorised as healed (complete re-epithelialisation in /=12 weeks, n=27) or non-healed (ulcer persisted for 12 weeks, n=26). Histological samples were scored by a blinded pathologist for seven histological parameters: presence of squamous cells; presence of epithelial cells; % volume of epithelium; hyperkeratosis; parakeratosis; fibrin; inflammation. Principle component analysis identified three clusters of variables which were used to generate wound healing indices: Structural Index (SI; parakeratosis, hyperkeratosis, presence of squamous and epithelial cells); Inflammatory Index (II; fibrin and inflammation); Epithelial Index (EI; % volume of epithelium). Results: No single histological variable could differentiate between healed and non-healed wounds. When clustered into indices, the SI differentiated between healed and non-healed DFUs (OR 10.04, 95% CI; 1.06 to 263, p = 0.044). Combining the three indices into a composite Wound Healing Prediction Score (WHPS), a significant difference between healed and non-healed wounds was found (ROC AUC 0.7, p = 0.016). An exploratory subgroup analysis of only non-infected wounds (n= 29, 15 healed, 14 non-healed) further improved the predictive performance of the WHPS (ROC AUC 0.764, p = 0.015). Conclusion: These preliminary results suggest that the WHPS generated by histological assessment of debrided material may help predict DFU outcome facilitating more aggressive intervention in earlier stages in those unlikely to heal. Disclosure J. Okiro: None. K. Fortune: None. E. Daly: None. C.M. Kilgallen: None. F. Quondamatteo: None. S. Sreenan: Other - Member of the organizing committee for the United Kingdom Consultant Diabetologists' forum, which is sponsored by Eli Lilly. Honorarium received; Current; Eli Lilly and Company. Other - Co-organizer of an educational event for trainee fellows in Endocrinology that is sponsored by the company. Food and lodging provided by the company; Ended; Novo Nordisk. Advisory Panel; Current; Novo Nordisk. Consultant; Ended; Eli Lilly and Company.
Okiro et al. (Fri,) studied this question.