Section of Infectious Diseases, Minneapolis VA Affairs Health Care System, 1 Veterans Drive, Minneapolis, MN, 111F55417, USA.
Department of Medicine, University of Minnesota Medical School, Minneapolis, MN, USA.
J Foot Ankle Res. 2023 Mar 16;16(1):13. doi: 10.1186/s13047-023-00610-6.
In adults with diabetes, diabetic foot ulcer (DFU) and amputation are common and associated with significant morbidity and mortality.
Identify tools predicting risk of DFU or amputation that are prognostically accurate and clinically feasible.
We searched for systematic reviews (SRs) of tools predicting DFU or amputation published in multiple databases from initiation to January, 2023. We assessed risk of bias (ROB) and provided a narrative review of reviews describing performance characteristics (calibration and discrimination) of prognostically accurate tools. For such tools, we additionally reviewed original studies to ascertain clinical applicability and usability (variables included, score calculation, and risk categorization).
We identified 3 eligible SRs predicting DFU or amputation risk. Two recent SRs (2020 and 2021) were rated as moderate and low ROB respectively. Four risk prediction models - Boyko, Martins-Mendes (simplified), Martins-Mendes (original), and PODUS 2020 had good prognostic accuracy for predicting DFU or amputation over time horizons ranging from 1- to 5-years. PODUS 2020 predicts absolute average risk (e.g., 6% risk of DFU at 2 years) and consists of 3-binary variables with a simple, summative scoring (0-4) making it feasible for clinic use. The other 3 models categorize risk subjectively (e.g., high-risk for DFU at 3 years), include 2-7 variables, and require a calculation device. No data exist to inform rescreening intervals. Furthermore, the effectiveness of targeted interventions in decreasing incidence of DFU or amputation in response to prediction scores is unknown.
In this review of reviews, we identified 4 prognostically accurate models that predict DFU or amputation in persons with diabetes. The PODUS 2020 model, predicting absolute average DFU risk at 2 years, has the most favorable prognostic accuracy and is clinically feasible. Rescreening intervals and effectiveness of intervention based on prediction score are uncertain.
在患有糖尿病的成年人中，糖尿病足溃疡（DFU）和截肢是常见的，且与较高的发病率和死亡率相关。
确定具有预后准确性和临床可行性的预测 DFU 或截肢风险的工具。
我们在多个数据库中搜索了从启动到 2023 年 1 月发表的预测 DFU 或截肢风险的工具的系统评价（SR）。我们评估了偏倚风险（ROB），并对具有预后准确性的工具的性能特征（校准和区分）进行了综述。对于这些工具，我们还回顾了原始研究，以确定临床适用性和可用性（包括变量、评分计算和风险分类）。
我们确定了 3 项符合条件的预测 DFU 或截肢风险的 SR。最近的两项 SR（2020 年和 2021 年）分别被评为中度和低度 ROB。四个风险预测模型——Boyko、Martins-Mendes（简化版）、Martins-Mendes（原始版）和 PODUS 2020 在 1 至 5 年的时间范围内具有良好的预后准确性，可预测 DFU 或截肢风险。PODUS 2020 预测绝对平均风险（例如，2 年内 DFU 的风险为 6%），由 3 个二分类变量组成，评分简单且累加（0-4），使其适用于临床使用。其他 3 个模型主观地分类风险（例如，3 年内 DFU 风险高），包括 2-7 个变量，并需要计算设备。没有数据可以告知重新筛查的间隔。此外，针对预测分数的目标干预措施在降低 DFU 或截肢发生率方面的有效性尚不清楚。
在本次综述中，我们确定了 4 个具有预后准确性的模型，可预测患有糖尿病的患者发生 DFU 或截肢的风险。PODUS 2020 模型预测 2 年内 DFU 的绝对平均风险，具有最佳的预后准确性和临床可行性。重新筛查间隔和基于预测分数的干预措施的有效性尚不确定。
