Objective To retrospectively analyze the clinical features and outcomes of diabetic foot ulcers(DFU), and investigate the effect of serum albumin(ALB) level on the amputation risk and medical cost of the disease. Methods A total of 789 inpatients with DFU in Center of Diabetes from January 2008 to December 2012 were enrolled and analyzed retrospectively in this study. They were divided into 3 groups based on their serum levels of ALB, moderate and severe hypoalbuminemia group (＜30g/L, n＝83), mild hypoalbuminemia group(30 to 35g/L, n＝163), and normal albumin group(≥35g/L, n＝543). These patients were also assigned into amputation group(n＝171), non-amputation group(n＝603), and death group(n=15) according to the clinical outcomes. Their clinical data, amputation rate, hospital days and medical cost were compared among those with different serum level of ALB. Results The total amputation rate was 21.7%, and the mortality was 1.9% in this cohort of patients. Of all these amputations, the major amputation rate(above-the-ankle amputation) was 22.8%, and the minor amputation rate was 77.2%(11.7% for below the ankle amputation and 65.5% for toe resection). For the patients without amputation, the average hospital stay was 30d and the medical cost was 26 610RMB, but for the patients with amputation, the stay was 49d and the cost was 49 456 RMB. The amputation rate, hospital stay, and medical cost in patients with mild, and moderate and severe hypoalbuminemia were 2.0-, 1.2- and 1.7-folds higher, and 2.9-, 1.5- and 2.3-folds higher, respectively, than those in patients with normal ALB level. Logistic regression analysis showed that the Wagner stage and severe infection were independent risk factors for amputation and the serum level of ALB was an independent protective factor. With the increase in serum ALB level, the amputation rate was lower, the hospital stay was shorter, and the medical cost decreased. Conclusion Serum ALB level is closely associated with amputation of DFU patients, and is a good predictor for the risk of amputation and medical cost.