The SINBAD score, a useful tool for predicting major adverse foot events in diabetic patients?

With diabetes on the rise worldwide, foot ulcers in diabetic patients are a major public health problem. In the United States, the cost is estimated at $80 billion every year.

To combat the progression of diabetic foot wounds, medicine recommends a a multidisciplinary approach, which generally makes it possible to reduce the risk of amputation by 45-55%: foot offloading, treatment of infection, septic surgery, revascularization, topical care, optimization of glycemic control, prevention of undernutrition…

The SINBAD score is an easy-to-use scoring system for monitoring patients with diabetic foot ulcers. However, its link with the occurrence of major adverse foot events (MAFEs) had not yet been studied.

The IHU ICAN teams therefore conducted a research project to assess the relationship between the SINBAD score and major adverse foot events in diabetic patients with foot ulcers. Publiées le 31 juillet dans Diabetes/Metabolism Research and Reviews, les conclusions sont résumées ci-dessous et consultables en version complète dans la publication “Use of the SINBAD score as a predicting tool for major adverse foot events in patients with diabetic foot ulcer : A French multicenter study”.

Read the scientific publication

The aim of the research project

  • A scientific hypothesis to be confirmed

The primary objective of this study was to evaluate the relationship between the SINBAD score and the risk of occurrence of at least one of 8 defined major adverse foot events:

  • Hospitalization,
  • Septic surgery,
  • Revascularization,
  • Minor amputation,
  • Major amputation,
  • Death,
  • Infection,
  • And ulcer recurrence.

The study hypothesis was that a high SINBAD score could be a predictor of major adverse foot events.

The secondary objective was to evaluate the relationship between the SINBAD score and the occurrence of each adverse event.

  • What is the SINBAD score?

The SINBAD score system is quick and easy to use, requiring no special equipment other than a clinical examination, and containing all the information needed for analysis by the patient’s medical team. It describes the following characteristics of the wound and its local and general environment:

  • S(ite): Wound location
  • I(schemia): Ischemia
  • N(europathy): neuropathy
  • B(infection bactérienne) : infection
  • A(rea): surface area
  • D(epth): wound depth

Research project methodology

  • Retrospective ancillary study.
  • Inclusion of 537 patients aged over 18 years attending a diabetic foot ulcer service for less than 12 months in 6 French hospitals.
  • Inclusion dates: between February 1, 2019 and March 17, 2019, and between February 1, 2020 and March 17, 2020.
  • Assessment of the SINBAD score at inclusion, then a follow-up period of 5 to 6 months with a new assessment of the frequency of major adverse foot events.

Study results

  • A low SINBAD score (0 to 3) was observed in 61% of patients and a high score (4 to 6) in 39%, with a major adverse foot event observed in 24% and 28% of patients respectively.
  • Multivariate analyses showed a significant relationship between SINBAD score and major adverse foot events.
  • The SINBAD score (continuous or dichotomous) at inclusion was also significantly associated with 6 of the 8 major adverse foot events.

The study proved that the SINBAD score could be used by the clinician, in addition to the simple prognosis of healing and amputation, to assess the risk of major adverse foot events: each SINBAD unit and an > score were associated with an increased risk of develop one of the 8 major adverse foot events.

The study concludes that the SINBAD score is a useful tool for improving foot ulcer management and predicting major adverse foot events (MAFEs).

It can be used in the same way as for the observation of major adverse cardiovascular events (MACE) in patients at cardiovascular risk.

Read the scientific publication

Study participants

  • Dr Georges Ha Van, Antoine Perrier, Service de diabétologie, AP-HP, Hôpital de la Pitié-Salpêtrière, Paris
  • Dr Sophie Schuldiner, Service de Maladies Métaboliques et Endocriniennes, Centre Hospitalier Universitaire de Nimes
  • Pr Ariane Sultan, Service endocrinologie, nutrition et diabétologie, CHU de Montpellier, PhyMedExp, INSERM U1046, CNRS UMR 9214, Université de Montpellier
  • Dr Benjamin Bouillet, Service Endocrinologie et diabétologie, CHU Dijon Bourgogne / INSERM / Université de Bourgogne Franche-Comté, LNC UMR1231, Dijon
  • Dr Jacques Martini, Service d’endocrinologie, CHU de Toulouse
  • Dr Julien Vouillarmet, Service d’endocrinologie, CHU de Lyon
  • Mehdi Menai, Aurélie Foucher, IHU ICAN, Fondation pour l’Innovation en Cardiométabolisme et Nutrition, Paris
  • Pr Agnès Hartemann, Dr Olivier Bourron, Sorbonne Université, Service de diabétologie, IHU ICAN, AP-HP, Hôpital Pitié-Salpêtrière