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

作　　者：王冰雪 林婷 吴静[1] 龚洪平 任妍 查盼盼 陈利鸿[1] 刘关键[3] 陈大伟[1] 王椿[1] 冉兴无[1] WANG Bingxue;LIN Ting;WU Jing;GONG Hongping;REN Yan;ZHA Panpan;CHEN Lihong;LIU Guanjian;CHEN Dawei;WANG Chun;RAN Xingwu(Diabetic Foot Care Center,Department of Endocrinology and Metabolism,West China Hospital,Sichuan University,Chengdu 610041,China;General Practice Medical Center,West China Hospital,Sichuan University,Chengdu 610041,China;Cochrane China Center,West China Hospital,Sichuan University,Chengdu 610041,China)

机构地区：[1]四川大学华西医院内分泌代谢科糖尿病足诊治中心,成都610041 [2]四川大学华西医院全科医学中心,成都610041 [3]四川大学华西医院中国循证医学中心,成都610041

出　　处：《四川大学学报（医学版）》2024年第4期972-979,共8页Journal of Sichuan University(Medical Sciences)

基　　金：四川省卫生健康委员会科技项目(临床研究专项)(No.23LCYJ 042);四川大学华西医院学科发展1.3.5工程项目(No.ZYGD18025)资助。

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 cm^(2)[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 cm^(2),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。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 cm^(2)(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 v

关 键 词：糖尿病足溃疡 住院时间延长 风险预测模型 内部验证 

分 类 号：R587.2[医药卫生—内分泌]