Risk factors for lower extremity amputation of inpatients with diabetic foot ulcers : a multi-center retrospective study
10.19405/j.cnki.issn1000-1492.2025.12.019
- VernacularTitle:糖尿病足溃疡住院患者下肢截肢风险因素的多中心回顾性研究
- Author:
Jie Zhao
1
;
Xiaodong Yang
2
;
Yuxin Hu
1
;
Wanxuan Hu
3
;
Yujie Hou
4
;
Bicheng Wang
5
;
Yexiang Sun
3
Author Information
1. Dept of Chinese Medicine ,The First Afiliated Hospital of Anhui Medical University Hefei 230022
2. Dept of General Surgery, The First Afiliated Hospital of Anhui Medical University Hefei 230022
3. Dept of Burns , The First Afiliated Hospital of Anhui Medical University Hefei 230022
4. Dept of Wound Repairing , The Second Afiliated Hospital of Hunan University of Chinese Medicine , Changsha 410005
5. Dept of Endocrine , Bengbu Hospital of Traditional Chinese Medicine , Bengbu 233080
- Publication Type:Journal Article
- Keywords:
diabetic foot ulcers;
inpatient;
lower extremity amputation;
risk factors;
multicenter;
retrospective study
- From:
Acta Universitatis Medicinalis Anhui
2025;60(12):2346-2352
- CountryChina
- Language:Chinese
-
Abstract:
Objective:To investigate independent risk factors for lower extremity amputation (LEA) in hospitalized patients with diabetic foot ulcers ( DFUs) .
Methods:A multicenter retrospective analysis was conducted on the clinical data of 329 DFUs hospitalized patients with diabetic foot ulcers from four general hospitals across the na⁃tion. A multivariate Logistic regression model was constructed , and prediction analysis was performed using R 4. 2. 1 . The discriminative ability of the model was assessed using receiver operating characteristic curves , while calibration accuracy and clinical applicability were evaluated via calibration curves and decision curve analysis.
Results :The study revealed that patients with higher education backgrounds showed lower disease severity (Wagnergrade) (Z = - 4. 331 , P < 0. 05) . A history of amputation , pre⁃existing lower extremity vascular disease , abnormal dorsalis pedis artery pulsation , and a history of coronary heart disease were significantly associated with the severity of DFUs , resulting in higher Wagner scores (P < 0. 05) . In the amputation prognosis analysis , prolonged duration of diabetes and elevated white blood cell count were positively correlated with amputation risk ( both P < 0. 01) .Multivariable regression identified non⁃higher education , low hemoglobin levels , decreased total cholesterol , and abnormally elevated platelet counts as independent risk factors for high Wagner grades ( ≥ grade 3 ) ( all P <0. 05) . The integrated predictive model incorporating these factors demonstrated strong discriminative performance ,with an area under curve of 0. 880 (95% CI: 0. 801 - 0. 960) . The calibration curve slope approached the ideal value , and decision curve analysis confirmed the model ′s clinical net benefit within a threshold probability range of 10% - 65% .
Conclusion:Lower education level , poor baseline nutritional status , infection , hypercoagulability ,and underlying vascular diseases collectively constitute key factors contributing to elevated amputation risk in DFUs patients. The developed predictive model exhibits high accuracy and may assist clinicians in formulating individual⁃ized intervention strategies.
- Full text:2026030323410969194糖尿病足溃疡住院患者下肢截肢风险因素的多中心回顾性研究_赵杰.pdf
