Development of a major amputation prediction model and nomogram in patients with diabetic foot

Background Diabetes mellitus, as one of the world's fastest-growing diseases, is a chronic metabolic disease that has now become a public health problem worldwide. The purpose of this research was to develop a predictive nomogram model to demonstrate the risk of major amputation in patients with diabetic foot.Methods A total of 634 Type 2 Diabetes Mellitus (T2DM) patients with diabetic foot ulcer hospitalized at the Air Force Medical Center between January 2018 and December 2023 were included in our retrospective study. There were 468 males (73.82%) and 166 females (26.18%) with an average age of 61.64 +/- 11.27 years and average body mass index of 24.45 +/- 3.56 kg/m2. The predictive factors were evaluated by single factor logistic regression and multiple logistic regression and the predictive nomogram was established with these features. Receiver operating characteristic (subject working characteristic curve) and their area under the curve, calibration curve, and decision curve analysis of this major amputation nomogram were assessed. Model validation was performed by the internal validation set, and the receiver operating characteristic curve, calibration curve, and decision curve analysis were used to further evaluate the nomogram model performance and clinical usefulness.Results Predictors contained in this predictive model included body mass index, ulcer sites, hemoglobin, neutrophil-to-lymphocyte ratio, blood uric acid (BUA), and ejection fraction. Good discrimination with a C-index of 0.957 (95% CI, 0.931-0.983) in the training group and a C-index of 0.987 (95% CI, 0.969-1.000) in the validation cohort were showed with this predictive model. Good calibration were displayed. The decision curve analysis showed that using the nomogram prediction model in the training cohort and validation cohort would respectively have clinical benefits.Conclusion This new nomogram incorporating body mass index, ulcer sites, hemoglobin, neutrophil-to-lymphocyte ratio, BUA, and ejection fraction has good accuracy and good predictive value for predicting the risk of major amputation in patients with diabetic foot. Key message What is already known on this topic - DF is a leading cause of amputations, with the characteristics of high incidence, great difficulty in treatment and high disability rate. There is still a lack of an accurate and clinically useful predictive model to assess the risk of amputation in DF patients. What this study adds - This study marks a significant advancement in estimating risk of major amputation in patients with DF and validating nomograms that incorporate BMI, ulcer sites, HB, NLR, BUA, and EF. How this study might affect research, practice or policy - It demonstrate the risk of major amputation in patients with DF and to propose prevention options, thereby providing a useful tool for early identification and development of the best therapeutic options, so as to prevent the occurrence of major amputation.