Sun Yujian, Zhou Yue, Dai Yu, Pan Yufan, Xiao Yi, Yu Yufeng
Chengdu University of Traditional Chinese Medicine, Chengdu, 610075, China.
J Tissue Viability. 2024 Nov;33(4):542-549. doi: 10.1016/j.jtv.2024.07.002.
Diabetic foot ulcer is one of the most prevalent, serious, and costly consequences of diabetes, often associated with peripheral neuropathy and peripheral arterial disease. These ulcers contribute to high disability and mortality rates in patients and pose a major challenge to clinical management.
To systematically review the risk prediction models for post-healing recurrence in diabetic foot ulcer (DFU) patients, so as to provide a reference for clinical staff to choose appropriate prediction models.
The authors searched five databases (Cochrane Library, PubMed, Web of Science, EMBASE, and Chinese Biomedical Database) from their inception to September 23, 2023, for relevant literature. After data extraction, the quality of the literature was evaluated using the Predictive Model Research Bias Risk and Suitability Assessment tool (PROBAST). Meta-analysis was performed using STATA 17.0 software.
A total of 9 studies involving 5956 patients were included. The recurrence rate after DFU healing ranged from 6.2 % to 41.4 %. Nine studies established 15 risk prediction models, and the area under the curve (AUC) ranged from 0.660 to 0.940, of which 12 models had an AUC≥0.7, indicating good prediction performance. The combined AUC value of the 9 validation models was 0.83 (95 % confidence interval: 0.79-0.88). Hosmer-Lemeshow test was performed for 10 models, external validation for 5 models, and internal validation for 6 models. Meta-analysis showed that 14 predictors, such as age and living alone, could predict post-healing recurrence in DFU patients (p < 0.05).
To enhance the quality of these risk prediction models, there is potential for future improvements in terms of follow-up duration, model calibration, and validation processes.
糖尿病足溃疡是糖尿病最常见、最严重且成本高昂的后果之一，常与周围神经病变和外周动脉疾病相关。这些溃疡导致患者出现高致残率和死亡率，给临床管理带来重大挑战。
系统评价糖尿病足溃疡（DFU）患者愈合后复发的风险预测模型，为临床工作人员选择合适的预测模型提供参考。
作者检索了五个数据库（考克兰图书馆、PubMed、科学网、EMBASE和中国生物医学数据库）自建库至2023年9月23日的相关文献。数据提取后，使用预测模型研究偏倚风险和适用性评估工具（PROBAST）对文献质量进行评估。使用STATA 17.0软件进行荟萃分析。
共纳入9项研究，涉及5956例患者。DFU愈合后的复发率为6.2%至41.4%。9项研究建立了15个风险预测模型，曲线下面积（AUC）为0.660至0.940，其中12个模型的AUC≥0.7，表明预测性能良好。9个验证模型的合并AUC值为0.83（95%置信区间：0.79 - 0.88）。对10个模型进行了Hosmer-Lemeshow检验，对5个模型进行了外部验证，对6个模型进行了内部验证。荟萃分析表明，年龄和独居等14个预测因素可预测DFU患者愈合后的复发情况（p < 0.05）。
为提高这些风险预测模型的质量，在随访时间、模型校准和验证过程方面未来有改进的潜力。
