Volume 39 Issue 12
Dec.  2023
Turn off MathJax
Article Contents
Guo QJ,Ouyang J,Rao JQ,et al.Construction and preliminary validation of a risk prediction model for the recurrence of diabetic foot ulcer in diabetic patients[J].Chin J Burns Wounds,2023,39(12):1149-1157.DOI: 10.3760/cma.j.cn501225-20231101-00166.
Citation: Guo QJ,Ouyang J,Rao JQ,et al.Construction and preliminary validation of a risk prediction model for the recurrence of diabetic foot ulcer in diabetic patients[J].Chin J Burns Wounds,2023,39(12):1149-1157.DOI: 10.3760/cma.j.cn501225-20231101-00166.

Construction and preliminary validation of a risk prediction model for the recurrence of diabetic foot ulcer in diabetic patients

doi: 10.3760/cma.j.cn501225-20231101-00166
Funds:

Guizhou Provincial Health Commission Science and Technology Fund Program gzwkj2023-585

Nursing Fund Project of Affiliated Hospital of Guizhou Medical University GYHLB202219

More Information
  •   Objective   To develop a risk prediction model for the recurrence of diabetic foot ulcer (DFU) in diabetic patients and primarily validate its predictive value.   Methods   Meta-analysis combined with retrospective cohort study was conducted. The Chinese and English papers on risk factors related to DFU recurrence publicly published in China Biology Medicine disc, China National Knowledge Infrastructure, Wanfang Database, VIP Database, and PubMed, Embase, Cochrane Library, and Web of Science, and the search time was from the establishment date of each database until March 31 st, 2022. The papers were screened and evaluated, the data were extracted, a meta-analysis was performed using RevMan 5.4.1 statistical software to screen risk factors for DFU recurrence, and Egger's linear regression was used to assess the publication bias of the study results. Risk factors for DFU recurrence mentioned in ≥3 studies and with statistically significant differences in the meta-analysis were selected as the independent variables to develop a logistic regression model for risk prediction of DFU recurrence. The medical records of 101 patients with DFU who met the inclusion criteria and were admitted to Affiliated Hospital of Guizhou Medical University from January 2019 to June 2022 were collected. There were 69 males and 32 females, aged (63±14) years. The receiver operating characteristic (ROC) curve of the predictive performance of the above constructed predictive model for DFU recurrence was drawn, and the area under the ROC curve, maximum Youden index, and sensitivity and specificity at the point were calculated. Dataset including data of 8 risk factors for DFU recurrence and the DFU recurrence rates of 10 000 cases was simulated using RStudio software and a scatter plot was drawn to determine two probabilities for risk division of DFU recurrence. Using the β coefficients corresponding to 8 DFU recurrence risk factors ×10 and taking the integer as the score of coefficient weight of each risk factor, the total score was obtained by summing up, and the cutoff scores for risk level division were calculated based on the total score × two probabilities for risk division of DFU recurrence.   Results   Finally, 20 papers were included, including 3 case-control studies and 17 cohort studies, with a total of 4 238 cases and DFU recurrence rate of 22.7% to 71.2%. Meta-analysis showed that glycosylated hemoglobin >7.5% and with plantar ulcer, diabetic peripheral neuropathy, diabetic peripheral vascular disease, smoking, osteomyelitis, history of amputation/toe amputation, and multidrug-resistant bacterial infection were risk factors for the recurrence of DFU (with odds ratios of 3.27, 3.66, 4.05, 3.94, 1.98, 7.17, 11.96, 3.61, 95% confidence intervals of 2.79-3.84, 2.06-6.50, 2.50-6.58, 2.65-5.84, 1.65-2.38, 2.29-22.47, 4.60-31.14, 3.13-4.17, respectively, P<0.05). There were no statistically significant differences in publication biases of diabetic peripheral neuropathy, diabetic peripheral vascular disease, glycosylated hemoglobin >7.5%, plantar ulcer, smoking, multidrug-resistant bacterial infection, or osteomyelitis ( P>0.05), but there was a statistically significant difference in the publication bias of amputation/toe amputation ( t=-30.39, P<0.05). The area under the ROC curve of the predictive model was 0.81 (with 95% confidence interval of 0.71-0.91) and the maximum Youden index was 0.59, at which the sensitivity was 72% and the specificity was 86%. Ultimately, 29.0% and 44.8% were identified respectively as the cutoff for dividing the probability of low risk and medium risk, and medium risk and high risk for DFU recurrence, while the corresponding total scores of low, medium, and high risks of DFU recurrence were <37, 37-57, and 58-118, respectively.   Conclusions   Eight risk factors for DFU recurrence are screened through meta-analysis and the risk prediction model for DFU recurrence is developed, which has moderate predictive accuracy and can provide guidance for healthcare workers to take interventions for patient with DFU recurrence risk.

     

  • loading
  • [1]
    HicksCW,SelvinE.Epidemiology of peripheral neuropathy and lower extremity disease in diabetes[J].Curr Diab Rep,2019,19(10):86.DOI: 10.1007/s11892-019-1212-8.
    [2]
    van NettenJJ,BusSA,ApelqvistJ,et al.Definitions and criteria for diabetic foot disease[J].Diabetes Metab Res Rev,2020,36Suppl 1:Se3268.DOI: 10.1002/dmrr.3268.
    [3]
    ArmstrongDG, BoultonAJM, BusSA. Diabetic foot ulcers and their recurrence[J]. N Engl J Med, 2017, 376(24):2367-2375. DOI: 10.1056/NEJMra1615439.
    [4]
    JiangY, WangX, XiaL, et al. A cohort study of diabetic patients and diabetic foot ulceration patients in China[J]. Wound Repair Regen, 2015,23(2):222-230. DOI: 10.1111/wrr.12263.
    [5]
    JiS,LiuX,HuangJ,et al.Consensus on the application of negative pressure wound therapy of diabetic foot wounds[J/OL].Burns Trauma,2021,9:tkab018[2023-11-01].https://pubmed.ncbi.nlm.nih.gov/34212064/.DOI: 10.1093/burnst/tkab018.
    [6]
    WangA,LvG,ChengX,et al.Guidelines on multidisciplinary approaches for the prevention and management of diabetic foot disease (2020 edition)[J/OL].Burns Trauma,2020,8:tkaa017[2023-11-01].https://pubmed.ncbi.nlm.nih.gov/32685563/.DOI: 10.1093/burnst/tkaa017.
    [7]
    StangA,JonasS,PooleC.Case study in major quotation errors: a critical commentary on the Newcastle-Ottawa scale[J].Eur J Epidemiol,2018,33(11):1025-1031.DOI: 10.1007/s10654-018-0443-3.
    [8]
    刘杨,罗健,刘苗,等.基于Meta分析构建ICU获得性衰弱风险预测模型[J].护理学杂志,2022,37(7):29-33.DOI: 10.3870/j.issn.1001-4152.2022.07.029.
    [9]
    SullivanLM,MassaroJM,SrD'Agostino RB.Presentation of multivariate data for clinical use: the Framingham Study risk score functions[J].Stat Med,2004,23(10):1631-1660.DOI: 10.1002/sim.1742.
    [10]
    王可,杨弘,田晶,等.基于Monte Carlo模拟的完全随机缺失数据处理方法效果比较[J].中国卫生统计,2020,37(2):298-301.
    [11]
    滕菲,井淇,王素珍,等.中国老年人轻度认知功能障碍风险评估的Rothman-Keller模型构建及应用[J].现代预防医学,2023,50(11):1932-1938.DOI: 10.20043/j.cnki.MPM.202212431.
    [12]
    杨逸昊,陈诗惠,黎宗军,等.急性缺血性脑卒中后癫痫危险因素的meta分析以及预测模型的建立[J].海南医学院学报,2023,29(11):838-849.DOI: 10.13210/j.cnki.jhmu.20221103.001.
    [13]
    钱泓洁 许蕾 张杉杉 糖尿病足溃疡治疗1年内不同阶段病情变化的随访分析 中华医学会第十一次全国内分泌学学术会议论文集 广州 2012 126 127

    钱泓洁,许蕾,张杉杉,等. 糖尿病足溃疡治疗1年内不同阶段病情变化的随访分析[C]//中华医学会第十一次全国内分泌学学术会议论文集,广州, 2012:126-127.

    [14]
    胡细玲,史力方,刘书红.2型糖尿病足溃疡复发的危险因素分析[J].当代护士(专科版),2014(4):23-24.
    [15]
    常小霞,袁丽,王芳,等.糖尿病足病人院外临床结局及相关因素分析[J].护理研究,2017,31(36):4634-4637.DOI: 10.3969/j.issn.1009-6493.2017.36.013.
    [16]
    谢朝云,陈应强,熊永发,等.糖尿病足溃疡创面治愈后复发的影响因素分析[J].中华老年多器官疾病杂志,2018,17(7):501-504.DOI: 10.11915/j.issn.1671-5403.2018.07.113.
    [17]
    莫泽纬,陈道雄,高勇义,等.初发糖尿病足溃疡患者足溃疡复发影响因素分析[J].中国热带医学,2018,18(7):716-719.DOI: 10.13604/j.cnki.46-1064/r.2018.07.21.
    [18]
    程玉霞, 赵凤卉, 朱平, 等. 复发性糖尿病足溃疡的危险因素分析 [J].北京医学, 2019, 41(11): 1024-1027.DOI: 10.15932/j.0253-9713.2019.11.016.
    [19]
    谢晓玲.糖尿病足溃疡创面伤口愈后复发的影响因素分析[J].护理实践与研究,2020,17(15):23-25.DOI: 10.3969/j.issn.1672-9676.2020.15.007.
    [20]
    申金付,蒋瑞妹,王卓群,等.2型糖尿病患者糖尿病足溃疡复发情况及影响因素[J].中华烧伤杂志,2020,36(10):947-952.DOI: 10.3760/cma.j.cn501120-20190726-00315.
    [21]
    王美君,许洪梅,葛甜甜,等.糖尿病足患者溃疡愈合后5年复发和死亡的随访结果及其危险因素分析[J].中华糖尿病杂志,2021,13(3):227-232.DOI: 10.3760/cma.j.cn115791-20200707-00422.
    [22]
    邬亦华,王瑞良,顾晔,等.奥扎格雷治疗老年糖尿病足患者的临床疗效及影响复发的相关因素分析[J].海军医学杂志,2021,42(1):90-93.DOI: 10.3969/j.issn.1009-0754.2021.01.025.
    [23]
    吕静,袁丽,李饶,等.糖尿病足溃疡复发风险预测模型的构建[J].护理研究,2022,36(6):993-998.DOI: 10.12102/j.issn.1009-6493.2022.06.009.
    [24]
    PetersEJ,ArmstrongDG,LaveryLA.Risk factors for recurrent diabetic foot ulcers: site matters[J].Diabetes Care,2007,30(8):2077-2079.DOI: 10.2337/dc07-0445.
    [25]
    DubskýM,JirkovskáA,BemR,et al.Risk factors for recurrence of diabetic foot ulcers: prospective follow-up analysis in the Eurodiale subgroup[J].Int Wound J,2013,10(5):555-561.DOI: 10.1111/j.1742-481X.2012.01022.x.
    [26]
    WaaijmanR,de HaartM,ArtsML,et al.Risk factors for plantar foot ulcer recurrence in neuropathic diabetic patients[J].Diabetes Care,2014,37(6):1697-1705.DOI: 10.2337/dc13-2470.
    [27]
    KhalifaWA.Risk factors for diabetic foot ulcer recurrence: a prospective 2-year follow-up study in Egypt[J].Foot (Edinb),2018,35:11-15.DOI: 10.1016/j.foot.2017.12.004.
    [28]
    TabanjehSF,HyassatD,JaddouH,et al.The frequency and risk factors of diabetic foot ulcer recurrence among Jordanian patients with diabetes[J].Curr Diabetes Rev,2020,16(8):910-915.DOI: 10.2174/1573399816666200109094329.
    [29]
    ChengY, ZuP, ZhaoJ, et al. Differences in initial versus recurrent diabetic foot ulcers at a specialized tertiary diabetic foot care center in China[J]. J Int Med Res, 2021,49(1):300060520987398. DOI: 10.1177/0300060520987398.
    [30]
    FelipeRR,Plata-QueMT.Predictors of outcomes of foot ulcers among individuals with type 2 diabetes mellitus in an outpatient foot clinic[J].J ASEAN Fed Endocr Soc,2021,36(2):189-195.DOI: 10.15605/jafes.036.02.14.
    [31]
    FournierC, SingboN, MorissetteN, et al. Outcomes of diabetic foot ulcers in a tertiary referral interdisciplinary clinic: a retrospective Canadian study[J]. Can J Diabetes, 2021,45(3):255-260. DOI: 10.1016/j.jcjd.2020.09.004.
    [32]
    GazzarusoC,GallottiP,PujiaA,et al.Predictors of healing, ulcer recurrence and persistence, amputation and mortality in type 2 diabetic patients with diabetic foot: a 10-year retrospective cohort study[J].Endocrine,2021,71(1):59-68.DOI: 10.1007/s12020-020-02431-0.
  • 加载中

Catalog

    通讯作者: 陈斌, bchen63@163.com
    • 1. 

      沈阳化工大学材料科学与工程学院 沈阳 110142

    1. 本站搜索
    2. 百度学术搜索
    3. 万方数据库搜索
    4. CNKI搜索

    Figures(3)  / Tables(1)

    Article Metrics

    Article views (247) PDF downloads(29) Cited by()
    Proportional views
    Related

    /

    DownLoad:  Full-Size Img  PowerPoint
    Return
    Return