Full
Outline
To develop and validate a prediction model for risk of amputation in patients with diabetic foot ulcers (DFU) based on systematic review and meta-analysis.
The studies on the risk factors of amputation in DFU patients was retrieved by using subject words+free words. After screening, 37 cohort studies were finally included, and the Newcastle-Ottawa scale (NOS) was used for quality evaluation. Meta-analysis was performed on the risk factors of amputation in DFU. Then a prediction model for DFU amputation risk were constructed based on the statistically significant risk factors in the meta-analysis. The corresponding β value was calculated based on the combined odds ratio (OR) value of each risk factor, and each risk factor was scored to establish a scoring system model. The clinical data of 453 DFU patients hospitalized in our department from 2021 to 2023 were collected as a validation cohort. Receiver operating characteristic (ROC) curve analysis was used to evaluate the model performance. The area under the curve (AUC) was calculated, and the optimal cutoff score was determined by calculation of the maximum Youden index through sensitivity and specificity.
Our meta-analysis showed a cumulative amputation rate of approximately 34.65% in 11 779 DFU patients. The final risk prediction models include gangrene [OR=11.92 (5.86~24.24)], ulcer depth [OR=4.93 (2.52~9.64)], osteomyelitis [OR=3.19 (2.36~4.29)], previous amputation history [OR=3.19 (2.00~5.09)] and lower extremity arterial disease [OR=3.10 (2.31~4.17)]. According to the weights of each risk factor, the total score of the model is 76, and the optimal cut-off score is 36.5. The prediction model performed well, with an AUC value of 0.864 (0.824, 0.903), a sensitivity of 0.743, a specificity of 0.859, and an accuracy rate of 83.00%.
A prediction model for DFU amputation risk is developed based on risk factor scoring, and has good discrimination and calibration, providing effective scientific basis for clinical research and clinical decision-making related to DFU amputation.
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| 科 Family | 属数 Number of genus | 种数 Number of species | 占总种数比例 Percentage of total species (%) | 属 Genus | 种数 Number of species | 占总种数比例 Percentage of total species (%) |
|---|---|---|---|---|---|---|
| 鹅膏菌科Amanitaceae | 2 | 11 | 5.26 | 鹅膏菌属 Amanita | 10 | 4.78 |
| 小菇科 Mycenaceae | 2 | 12 | 5.74 | 丝盖伞属 Inocybe | 5 | 2.39 |
| 多孔菌科 Polyporaceae | 8 | 14 | 6.70 | 蜡蘑属 Laccaria | 5 | 2.39 |
| 红菇科 Russulaceae | 3 | 23 | 11.00 | 小皮伞属 Marasmius | 6 | 2.87 |
| 小菇属 Mycena | 11 | 5.26 | ||||
| 光柄菇属 Pluteus | 5 | 2.39 | ||||
| 红菇属 Russula | 17 | 8.13 | ||||
| 栓菌属 Trametes | 5 | 2.39 |
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