A potent weighted risk model for evaluating the occurrence and severity of diabetic foot ulcers

Lu Shi,Dandan Liu,Zhiying Li,Qingbin Zhao,Yueying Zhang,Xiaoxian Chi,Huiyi Wei,Dandan Chang,Xiaodan Wang,Tianxiao Zhang

doi:10.1186/s13098-021-00711-x

Abstract

BackgroundDiabetic foot ulcer (DFU) is a serious chronic complication of diabetes. This study aimed to establish weighted risk models for determining DFU occurrence and severity in diabetic patients.MethodsThis was a multi-center hospital-based cross-sectional study. A total of 1488 diabetic patients with or without an ulcer from three tertiary hospitals were included in the study. Random forest method was used to develop weighted risk models for assessing DFU risk and severity. Receiver operating characteristic curves were used to validate the models and calculate the optimal cut-off values of the important risk factors.ResultsWe developed potent weighted risk models for evaluating DFU occurrence and severity. The top eight important risk factors for DFU onset were plasma fibrinogen, neutrophil percentage and hemoglobin levels in whole blood, stroke, estimated glomerular filtration rate, age, duration of diabetes, and serum albumin levels. The top 10 important risk factors for DFU severity were serum albumin, neutrophil percentage and hemoglobin levels in whole blood, plasma fibrinogen, hemoglobin A1c, estimated glomerular filtration rate, hypertension, serum uric acid, diabetic retinopathy, and sex. Furthermore, the area under curve values in the models using plasma fibrinogen as a single risk factor for determining DFU risk and severity were 0.86 (sensitivity 0.74, specificity 0.87) and 0.73 (sensitivity 0.76, specificity 0.58), respectively. The optimal cut-off values of plasma fibrinogen for determining DFU risk and severity were 3.88 g/L and 4.74 g/L, respectively.ConclusionsWe have established potent weighted risk models for DFU onset and severity, based on which precise prevention strategies can be formulated. Modification of important risk factors may help reduce the incidence and progression of DFUs in diabetic patients.

Highlights

Diabetic foot ulcer (DFU) is a serious chronic complication of diabetes
Hypertension, diabetic retinopathy (DR), family history of diabetes, and Serum uric acid (SUA) levels were only identified to be significantly different between controls and cases in Set1
We demonstrated that plasma fibrinogen was a risk factor for the onset and severity of DFUs, but it had a high weight in the co-participation of multiple risk factors, especially in the risk model for DFU severity

Summary

Introduction

Diabetic foot ulcer (DFU) is a serious chronic complication of diabetes. Diabetic foot ulcer (DFU) is a severe diabetic complication that consists of lesions in the deep tissues associated with neurological disorders and peripheral arterial disease (PAD) in the lower limbs [1]. DFUs are a devastating component of diabetes progression, and an estimated 15% of diabetic patients develop foot ulcers during the course of their disease [5, 6]. The commonly identified risk factors predisposing to the development of foot ulcers include poor glycemic control, peripheral neuropathy, and PAD. Foot ulcer severity has been associated with the worst outcomes and a higher rate of lower limb amputation among diabetic patients. Preventing the occurrence and progression of foot ulcers is very important to reduce poor outcomes in diabetic patients

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