糖尿病足溃疡患者住院时间延长风险预测模型构建及验证

王冰雪; 林婷; 吴静; 龚洪平; 任妍; 查盼盼; 陈利鸿; 刘关键; 陈大伟; 王椿; 冉兴无

doi:10.12182/20240760507

糖尿病足溃疡患者住院时间延长风险预测模型构建及验证

Development and Validation of a Risk Prediction Model for Prolonged Hospitalization in Patients With Diabetic Foot Ulcers

摘要

摘要:
目的探究糖尿病足溃疡（diabetic foot ulcers, DFU）患者住院时间延长的危险因素，构建预测模型并进行内部验证。
方法回顾性收集2012年1月–2022年12月四川大学华西医院收治的住院DFU患者临床资料，并以7∶3随机拆分数据分配至训练队列与验证队列，将住院时间≥上四分位数确定为住院时间延长，采用训练队列分析其危险因素并建立风险预测模型，应用验证队列对模型进行验证。
结果共纳入住院DFU患者967例，其中245例患者住院时间延长。训练队列共676例，验证队列291例。多因素logistic 回归分析显示，吸烟史〔比值比（odds ratio, OR）=1.67，95%置信区间（confidence interval, CI）（1.13，2.48），P=0.010〕、Wagner分级≥3〔OR=7.13，95%CI （3.68，13.83）， P<0.001〕、中足溃疡〔OR=1.99，95%CI （1.07，3.72），P=0.030〕、后足溃疡〔OR=3.68，95%CI （1.83，7.41），P<0.001〕、多部位溃疡〔OR=2.91，95%CI （1.80， 4.69），P<0.001〕、溃疡面积≥3 cm²〔OR=2.00，95%CI （1.28，3.11），P=0.002〕、白细胞计数〔OR=1.11， 95%CI （1.05，1.18），P<0.001〕是DFU患者住院时间延长的危险因素。基于危险因素构建列线图，训练队列和验证队列受试者工作特征曲线的曲线下面积分别为0.782 （95%CI 0.745，0.820）及0.756 （95%CI 0.694，0.818），校准曲线显示预测概率与实际概率具有较高的一致性。
结论吸烟史，Wagner分级≥3，中、后足及多部位溃疡，溃疡面积≥3 cm²，以及白细胞计数升高是DFU患者住院时间延长的危险因素，临床医师应加强对患者全面评估，采取合理诊疗措施以缩短住院时间。

Abstract:
Objective To investigate the risk factors associated with prolonged hospitalization in patients diagnosed with diabetic foot ulcers (DFU), to develop a predictive model, and to conduct internal validation of the model.
Methods The clinical data of DFU patients admitted to West China Hospital, Sichuan University between January 2012 and December 2022 were retrospectively collected. The subjects were randomly assigned to a training cohort and a validation cohort at a ratio of 7 to 3. Hospital stays longer than 75th percentile were defined as prolonged length-of-stay. A thorough analysis of the risk factors was conducted using the training cohort, which enabled the development of an accurate risk prediction model. To ensure robustness, the model was internally validated using the validation cohort.
Results A total of 967 inpatients with DFU were included, among whom 245 patients were identified as having an extended length-of-stay. The training cohort consisted of 622 patients, while the validation cohort comprised 291 patients. Multivariate logistic regression analysis revealed that smoking history (odds ratio OR=1.67, 95% confidence interval CI, 1.13 to 2.48, P=0.010), Wagner grade 3 or higher (OR=7.13, 95% CI, 3.68 to 13.83, P<0.001), midfoot ulcers (OR=1.99, 95% CI, 1.07 to 3.72, P=0.030), posterior foot ulcers (OR=3.68, 95% CI, 1.83 to 7.41, P<0.001), multisite ulcers (OR=2.91, 95% CI, 1.80 to 4.69, P<0.001), wound size≥3 cm² (OR=2.00, 95% CI, 1.28-3.11, P=0.002), and white blood cell count (OR=1.11, 95% CI, 1.05 to 1.18, P<0.001) were associated with an increased risk of prolonged length of stay. Additionally, a nomogram was constructed based on the identified risk factors. The areas under the receiver operating characteristic (ROC) curves for both the training cohort and the validation cohort were 0.782 (95% CI, 0.745 to 0.820) and 0.756 (95% CI, 0.694 to 0.818), respectively, indicating robust predictive performance. Furthermore, the calibration plot demonstrated optimal concordance between the predicted probabilities and the observed outcomes in both the training and the validation cohorts.
Conclusion Smoking history, Wagner grade≥3, midfoot ulcers, posterior foot ulcers, multisite ulcers, ulcer area≥3 cm², and elevated white blood cell count are identified as independent predictors of prolonged hospitalization. Therefore, it is imperative that clinicians conduct a comprehensive patient evaluation and implement appropriate diagnostic and therapeutic strategies to effectively shorten the length of stay for DFU patients.

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