1. [Development of a Diabetic Foot Ulceration Prediction Model and Nomogram]
- Author
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Sookyung Hyun, Seung Hun Woo, Chang Wan Kang, Eun Joo Lee, Eun Jin Han, Ihn Sook Jeong, and Hyuk Jae Jung
- Subjects
Adult ,Male ,medicine.medical_specialty ,medicine.medical_treatment ,Concordance ,Diabetes Complications ,03 medical and health sciences ,0302 clinical medicine ,Risk Factors ,Diabetes mellitus ,Internal medicine ,Republic of Korea ,medicine ,Diabetes Mellitus ,Humans ,Foot Ulcer ,General Nursing ,030504 nursing ,business.industry ,Nomogram ,medicine.disease ,Confidence interval ,Diabetic Foot ,Nomograms ,Peripheral neuropathy ,Amputation ,030220 oncology & carcinogenesis ,Case-Control Studies ,0305 other medical science ,business ,Foot (unit) ,Kidney disease - Abstract
Purpose This study aimed to identify the risk factors for diabetic foot ulceration (DFU) to develop and evaluate the performance of a DFU prediction model and nomogram among people with diabetes mellitus (DM). Methods This unmatched case-control study was conducted with 379 adult patients (118 patients with DM and 261 controls) from four general hospitals in South Korea. Data were collected through a structured questionnaire, foot examination, and review of patients' electronic health records. Multiple logistic regression analysis was performed to build the DFU prediction model and nomogram. Further, their performance was analyzed using the Lemeshow-Hosmer test, concordance statistic (C-statistic), and sensitivity/specificity analyses in training and test samples. Results The prediction model was based on risk factors including previous foot ulcer or amputation, peripheral vascular disease, peripheral neuropathy, current smoking, and chronic kidney disease. The calibration of the DFU nomogram was appropriate (χ² = 5.85, p = .321). The C-statistic of the DFU nomogram was .95 (95% confidence interval .93~.97) for both the training and test samples. For clinical usefulness, the sensitivity and specificity obtained were 88.5% and 85.7%, respectively at 110 points in the training sample. The performance of the nomogram was better in male patients or those having DM for more than 10 years. Conclusion The nomogram of the DFU prediction model shows good performance, and is thereby recommended for monitoring the risk of DFU and preventing the occurrence of DFU in people with DM.
- Published
- 2020