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Article Navigation >  CHINESE JOURNAL OF BURNS AND WOUNDS  >  > Accepted Manuscript
Ma Hairong,Zheng Liran,Chen Jiageng,et al.Analysis of influencing factors of diabetic foot ulcer recurrence and construction of the Bayesian network model[J].Chin J Burns Wounds,2026,42(11):1-9.DOI: 10.3760/cma.j.cn501225-20250805-00347.
Citation: Ma Hairong,Zheng Liran,Chen Jiageng,et al.Analysis of influencing factors of diabetic foot ulcer recurrence and construction of the Bayesian network model[J].Chin J Burns Wounds,2026,42(11):1-9.DOI: 10.3760/cma.j.cn501225-20250805-00347.
shu

Analysis of influencing factors of diabetic foot ulcer recurrence and construction of the Bayesian network model

doi: 10.3760/cma.j.cn501225-20250805-00347
  • 1.

    School of Nursing, Tianjin University of Traditional Chinese Medicine, Tianjin 301617, China

  • 2.

    National Health Commission Key Lab of Hormones and Development and Tianjin Key Lab of Metabolic Diseases, Diabetic Podiatry Department, Tianjin Medical University Chu Hsien-I Memorial HospitalInstitute of Endocrinology, Tianjin 300134, China

  • 3.

    Department of Human Resources, Tianjin Medical University, Tianjin 301617, China

  • 4.

    School of Nursing, Tianjin Medical University, Tianjin 301617, China

Funds:

General Program of National Natural Science Foundation of China 81973614

Special Scientific Research Fund of Nursing Discipline Promotion Program of Tianjin Medical University 2024XKHL18

More Information
  • Corresponding author: Wang Meijun, Email: 0532022@163.com
  • Received Date: 2025-08-05
    Available Online: 2026-11-06
    Abstract
  •   Objective  To explore the influencing factors of diabetic foot ulcer (DFU) recurrence, construct the Bayesian network model for predicting DFU recurrence, and investigate the interrelationships among these influencing factors and their effects on DFU recurrence.  Methods  This study was a retrospective cohort study. From April 2016 to April 2020, 1 656 hospitalized DFU patients who met the inclusion criteria were admitted to the Diabetic Podiatry Department of Tianjin Medical University Chu Hsien-I Memorial Hospital, including 1 127 males and 529 females, aged 18-80 years. According to DFU recurrence status within 5 years after discharge, the patients were divided into recurrence group (552 cases) and non-recurrence group (1 104 cases). The following indicators were compared between the two groups, including gender, duration of diabetes, retinopathy status, ulcer location, foot deformity, history of foot amputation, body mass index (BMI), systolic blood pressure, levels of D-dimer, fibrinogen, total cholesterol, and low-density lipoprotein (LDL) on the day of admission, level of glycated hemoglobin A1c (HbA1c) during hospitalization, hypoglycemic regimen, and use of aspirin and statins. A multivariate logistic regression model was used to identify independent risk factors for DFU recurrence. A restricted cubic spline model was applied to analyze the dose-response relationship between level of HbA1c during hospitalization and DFU recurrence after adjusting covariates. A Bayesian network model for predicting DFU recurrence was established to analyze the interrelationships among these influencing factors and their effects on DFU recurrence. The receiver operating characteristic (ROC) curve was plotted to evaluate the predictive performance of the Bayesian network model for DFU recurrence.  Results  There were statistically significant differences between the two groups of patients in gender, retinopathy status, ulcer location, foot deformity, history of foot amputation, hypoglycemic regimen, and use of aspirin and statins (with χ² values of 5.87, 6.14, 24.97, 159.63, 4.03, 39.07, 26.60, and 4.69, respectively, P<0.05), as well as duration of diabetes, BMI, systolic blood pressure, and levels of D-dimer, fibrinogen, total cholesterol, and LDL on the day of admission, and level of HbA1c during hospitalization (with Z values of -7.20, -6.14, -5.57, -2.24, -9.09, -2.08, -7.74, and -11.32, respectively, P<0.05). Multivariate logistic regression analysis showed that BMI, systolic blood pressure, levels of fibrinogen and LDL on the day of admission, level of HbA1c during hospitalization, duration of diabetes, ulcer location, foot deformity, hypoglycemic regimens of injecting insulin and oral hypoglycemic agents + injecting insulin, and use of aspirin were the independent risk factors for DFU recurrence (with OR values of 1.06, 1.01, 1.31, 1.47, 1.19, 1.04, 1.71, 6.59, 1.82, 1.60, and 1.85, respectively, 95%CI of 1.03-1.10, 1.01-1.02, 1.21-1.43, 1.29-1.68, 1.13-1.26, 1.03-1.06, 1.26-2.31, 4.67-9.38, 1.19-2.80, 1.18-2.16, and 1.45-2.38, respectively, P<0.05). Restricted cubic spline model showed a non-linear dose-response relationship between level of HbA1c ≥9.0% during hospitalization and DFU recurrence risk after adjusting covariates (χ²=15.01, P<0.05). The constructed Bayesian network model consisted of 10 nodes and 14 directed edges. The model demonstrated that ulcer location, use of aspirin, foot deformity, and levels of LDL and BMI on the day of admission were directly associated with DFU recurrence; foot deformity posed the greatest risk for DFU recurrence, followed by ulcer location and use of aspirin. The area under the ROC curve for the Bayesian network model was 0.74 (95%CI of 0.70-0.78).  Conclusions  The BMI, systolic blood pressure, levels of fibrinogen and LDL on the day of admission, level of HbA1c during hospitalization, duration of diabetes, ulcer location, foot deformity, hypoglycemic regimens, and use of aspirin were the independent risk factors for DFU recurrence. The ulcer location, use of aspirin, foot deformity, and levels of LDL and BMI on the day of admission were directly associated with DFU recurrence.

     

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