Development of Predictive Nomograms for Clinical Use to Quantify the Risk of Amputation in Patients with Diabetic Foot Ulcer

Objective. To determine the novel proposed nomogram model accuracy in the prediction of the lower-extremity amputations (LEA) risk in diabetic foot ulcer (DFU). Methods and Materials. In this retrospective study, data of 125 patients with diabetic foot ulcer who met the research criteria in Zhongnan Hospital of Wuhan University from January 2015 to December 2019 were collected by filling in the clinical investigation case report form. Firstly, univariate analysis was used to find the primary predictive factors of amputation in patients with diabetic foot ulcer. Secondly, single factor and multiple factor logistic regression analysis were employed to screen the independent influencing factors of amputation introducing the primary predictive factors selected from the univariate analysis. Thirdly, the independent influencing factors were applied to build a prediction model of amputation risk in patients with diabetic foot ulcer by using R4.3; then, the nomogram was established according to the selected variables visually. Finally, the performance of the prediction model was evaluated and verified by receiver working characteristic (ROC) curve, corrected calibration curve, and clinical decision curve. Results. 7 primary predictive factors were selected by univariate analysis from 21 variables, including the course of diabetes, peripheral angiopathy of diabetic (PAD), glycosylated hemoglobin A1c (HbA1c), white blood cells (WBC), albumin (ALB), blood uric acid (BUA), and fibrinogen (FIB); single factor logistic regression analysis showed that albumin was a protective factor for amputation in patients with diabetic foot ulcer, and the other six factors were risk factors. Multivariate logical regression analysis illustrated that only five factors (the course of diabetes, PAD, HbA1c, WBC, and FIB) were independent risk factors for amputation in patients with diabetic foot ulcer. According to the area under curve (AUC) of ROC was 0.876 and corrected calibration curve of the nomogram displayed good fitting ability, the model established by these 5 independent risk factors exhibited good ability to predict the risk of amputation. The decision analysis curve (DCA) indicated that the nomogram model was more practical and accurate when the risk threshold was between 6% and 91%. Conclusion. Our novel proposed nomogram showed that the course of diabetes, PAD, HbA1c, WBC, and FIB are the independent risk factors of amputation in patients with DFU. This prediction model was well developed and behaved a great accurate value for LEA so as to provide a useful tool for screening LEA risk and preventing DFU from developing into amputation.

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Incidence and Risk Factors of Diabetic Foot Ulcer: A Population-Based Diabetic Foot Cohort (ADFC Study)—Two-Year Follow-Up Study

International Journal of Endocrinology ◽

10.1155/2018/7631659 ◽

2018 ◽

Vol 2018 ◽

pp. 1-9 ◽

Cited By ~ 18

Author(s):

Leila Yazdanpanah ◽

Hajieh Shahbazian ◽

Iraj Nazari ◽

Hamid Reza Arti ◽

Fatemeh Ahmadi ◽

...

Keyword(s):

Risk Factors ◽

Diabetic Foot ◽

Univariate Analysis ◽

Previous History ◽

Foot Ulcer ◽

Diabetic Foot Ulcer ◽

Population Based ◽

University Hospital ◽

Foot Deformity ◽

History Of

Aim/Introduction. This study was carried out to assess the incidence and risk factors of diabetic foot ulcer (DFU). Materials and Methods. In this prospective cohort study in a university hospital, all the participants were examined and followed up for new DFU as final outcome for two years. To analyze the data, the variables were first evaluated with a univariate analysis. Then variables with P value < 0.2 were tested with a multivariate analysis, using backward-elimination multiple logistic regression. Results. Among 605 patients, 39 cases had DFU, so we followed up the remaining 566 patients without any present or history of DFU. A two-year cumulative incidence of diabetic foot ulcer was 5.62% (95% CI 3.89–8.02). After analysis, previous history of DFU or amputation [OR = 9.65, 95% CI (2.13–43.78), P value = 0.003], insulin usage [OR = 5.78, 95% CI (2.37–14.07), P value < 0.01], gender [OR = 3.23, 95% CI (1.33–7.83), P value = 0.01], distal neuropathy [OR = 3.37, 95% CI (1.40–8.09), P value = 0.007], and foot deformity [OR = 3.02, 95% CI (1.10–8.29), P value = 0.032] had a statistically significant relationship with DFU incidence. Conclusion. Our data showed that the average annual DFU incidence is about 2.8%. Independent risk factors of DFU development were previous history of DFU or amputation, insulin consumption, gender, distal neuropathy, and foot deformity. These findings provide support for a multifactorial etiology for DFU.

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Elevated serum uric acid levels are independent risk factors for diabetic foot ulcer in female Chinese patients with type 2 diabetes (血尿酸水平升高是中国女性2型糖尿病患者糖尿病足溃疡的独立危险因素)

Journal of Diabetes ◽

10.1111/1753-0407.12079 ◽

2013 ◽

Vol 6 (1) ◽

pp. 42-47 ◽

Cited By ~ 9

Author(s):

Xiao Ye ◽

Ying Cao ◽

Fang Gao ◽

Qunying Yang ◽

Qian Zhang ◽

...

Keyword(s):

Risk Factors ◽

Type 2 Diabetes ◽

Uric Acid ◽

Diabetic Foot ◽

Elevated Serum ◽

Foot Ulcer ◽

Diabetic Foot Ulcer ◽

Chinese Patients ◽

Independent Risk Factors

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Risk factors associated with adverse outcomes in a population-based prospective cohort study of people with their first diabetic foot ulcer

Journal of Diabetes and its Complications ◽

10.1016/j.jdiacomp.2007.09.004 ◽

2007 ◽

Vol 21 (6) ◽

pp. 341-349 ◽

Cited By ~ 84

Author(s):

Kirsty Winkley ◽

Daniel Stahl ◽

Trudie Chalder ◽

Michael E. Edmonds ◽

Khalida Ismail

Keyword(s):

Risk Factors ◽

Cohort Study ◽

Prospective Cohort Study ◽

Diabetic Foot ◽

Prospective Cohort ◽

Foot Ulcer ◽

Diabetic Foot Ulcer ◽

Population Based ◽

Adverse Outcomes ◽

Factors Associated

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A clinico-microbiological study of diabetic foot ulcer patients to identify risk factors and their correlation with prognosis in tertiary care hospital in India

International Surgery Journal ◽

10.18203/2349-2902.isj20161141 ◽

2016 ◽

pp. 669-673 ◽

Cited By ~ 1

Author(s):

Arun Anand ◽

Indu Biswal ◽

Rajesh Soni ◽

Ajit Sinha ◽

Dabet Rynga ◽

...

Keyword(s):

Risk Factors ◽

Diabetic Foot ◽

Tertiary Care Hospital ◽

Tertiary Care ◽

Foot Ulcer ◽

Diabetic Foot Ulcer ◽

Care Hospital ◽

Microbiological Study

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Causation Research on Diabetic Foot Complications—What I Learned From Roger Pecoraro: The 2021 Roger E. Pecoraro Award Lecture

10.2337/figshare.15048282 ◽

2021 ◽

Author(s):

Edward J. Boyko

Keyword(s):

Risk Factors ◽

Diabetic Foot ◽

Past History ◽

Foot Ulcer ◽

Diabetic Foot Ulcer ◽

Clinical Information ◽

Arterial Perfusion ◽

Primary Care Population ◽

Foot Complications ◽

Patients With Diabetes

Roger Pecoraro made important contribution to diabetic foot research and is primarily responsible for instilling in me an interest in these complications. Our collaboration in the final years of his life led to the development of the Seattle Diabetic Foot Study. At the time it began, the Seattle Diabetic Foot Study was perhaps unique in being a prospective study of diabetic foot ulcer conducted in a non-specialty primary care population of patients with diabetes and without foot ulcer. Important findings from this research include the demonstration that neurovascular measurements, diabetes characteristics, past history of ulcer or amputation, body weight, and poor vision all significantly and independently predict foot ulcer risk. A prediction model from this research that included only readily available clinical information showed excellent ability to discriminate between patients who did and did not develop ulcer during follow-up (area under ROC curve=0.81 at one year). Identification of limb-specific amputation risk factors showed considerable overlap with those risk factors identified for foot ulcer, but suggested arterial perfusion as playing a more important role. Risk of foot ulcer in relation to peak plantar pressure estimated at the site of the pressure measurement showed a significant association over the metatarsal heads, but not other foot locations, suggesting that the association between pressure and this outcome may differ by foot location. The Seattle Diabetic Foot Study has helped to expand our knowledge base on risk factors and potential causes of foot complications. Translating this information into preventive interventions remains a continuing challenge.

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