■为了调查与诊断为糖尿病足溃疡(DFU)的患者长期住院相关的危险因素,开发一个预测模型,并对模型进行内部验证。
■华西医院收治的DFU患者的临床资料,对四川大学2012年1月至2022年12月间的资料进行回顾性收集。以7比3的比例将受试者随机分配到训练队列和验证队列。住院时间超过第75百分位数被定义为住院时间延长。使用训练队列对风险因素进行了全面分析,这使得能够开发出准确的风险预测模型。为了确保鲁棒性,使用验证队列对模型进行了内部验证.
■共纳入了967例DFU患者,其中245例患者被确定为住院时间延长.训练组由622名患者组成,而验证队列包括291例患者。多因素logistic回归分析显示吸烟史(比值比[OR]=1.67,95%置信区间[CI],1.13至2.48,P=0.010),瓦格纳3级或更高(OR=7.13,95%CI,3.68至13.83,P<0.001),足中部溃疡(OR=1.99,95%CI,1.07~3.72,P=0.030),足后部溃疡(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),伤口大小≥3cm2(OR=2.00,95%CI,1.28-3.11,P=0.002),和白细胞计数(OR=1.11,95%CI,1.05至1.18,P<0.001)与住院时间延长的风险增加相关。此外,根据已确定的风险因素构建列线图.训练队列和验证队列的受试者工作特征(ROC)曲线下面积分别为0.782(95%CI,0.745至0.820)和0.756(95%CI,0.694至0.818),分别,表明了强大的预测性能。此外,校准图显示了训练和验证队列中预测概率和观察结果之间的最佳一致性.
■吸烟史,Wagner≥3级,足中部溃疡,足后部溃疡,多部位溃疡,溃疡面积≥3cm2和白细胞计数升高被认为是住院时间延长的独立预测因素.因此,临床医生必须进行全面的患者评估,并实施适当的诊断和治疗策略,以有效缩短DFU患者的住院时间.
UNASSIGNED: 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.
UNASSIGNED: 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.
UNASSIGNED: 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.
UNASSIGNED: 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.