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已发表论文
从溃疡到截肢：糖尿病足溃疡截肢预后模型的系统综述
Authors Xie XR, Yu MF, Xu R, Liu Y, Zhang J
Received 22 May 2025
Accepted for publication 31 August 2025
Published 18 September 2025 Volume 2025:18 Pages 3099—3111
DOI https://doi.org/10.2147/RMHP.S542262
Checked for plagiarism Yes
Review by Single anonymous peer review
Peer reviewer comments 3
Editor who approved publication: Dr Gulsum Kaya
Xiao-Ran Xie,1,* Ming-Feng Yu,1,* Rong Xu,1 Yu Liu,1 Jing Zhang1,2
1Department of Nursing, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, People’s Republic of China; 2Department of Endocrinology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, People’s Republic of China
*These authors contributed equally to this work
Correspondence: Rong Xu, Department of Nursing, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, People’s Republic of China, Email nfmxr@126.com Yu Liu, Department of Nursing, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, People’s Republic of China, Email yliu@tjh.tjmu.edu.cn
Aim: To systematically analyze and compare studies on risk prediction models for diabetic foot ulcers progressing to amputation, facilitate clinical decision-making, and provide recommendations for improving modeling strategies in future research.
Methods: We searched Medline, Embase, Cochrane Library, and Clinicaltrials.gov from inception to January 29, 2025, to identify studies on risk prediction models for diabetic foot ulcers progressing to amputation. After study screening and data extraction, we evaluated bias and applicability using the Prediction Model Risk of Bias Assessment Tool.
Results: We included 18 papers comprising 15 development studies and 3 external validation studies. The development studies reported 17 models, while the validation studies externally validated 12 models. The area under the curve of all models ranged from 0.557 to 0.957. The most commonly used predictors were peripheral arterial disease, glycated hemoglobin, infection, Wagner classification, and ulcer depth. All included studies had low concerns regarding applicability but exhibited high risk of bias, primarily due to insufficient events per variable, missing data, inadequate consideration of data complexity, lack of model performance assessment, and absence of internal validation.
Conclusion: Risk prediction model research for diabetic foot ulcer progression to amputation remains in its early stages. Future efforts should prioritize prospectively developing and externally validating models with robust performance and low bias, accompanied by rigorous internal validation and transparent reporting. (Funding: Natural Science Foundation of Hubei Province (2022CFB145) and Research Fund of Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology (2023D36)).
Keywords: diabetes foot, amputation, forecasting, models, systematic review
1Department of Nursing, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, People’s Republic of China; 2Department of Endocrinology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, People’s Republic of China
*These authors contributed equally to this work
Correspondence: Rong Xu, Department of Nursing, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, People’s Republic of China, Email nfmxr@126.com Yu Liu, Department of Nursing, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, People’s Republic of China, Email yliu@tjh.tjmu.edu.cn
Aim: To systematically analyze and compare studies on risk prediction models for diabetic foot ulcers progressing to amputation, facilitate clinical decision-making, and provide recommendations for improving modeling strategies in future research.
Methods: We searched Medline, Embase, Cochrane Library, and Clinicaltrials.gov from inception to January 29, 2025, to identify studies on risk prediction models for diabetic foot ulcers progressing to amputation. After study screening and data extraction, we evaluated bias and applicability using the Prediction Model Risk of Bias Assessment Tool.
Results: We included 18 papers comprising 15 development studies and 3 external validation studies. The development studies reported 17 models, while the validation studies externally validated 12 models. The area under the curve of all models ranged from 0.557 to 0.957. The most commonly used predictors were peripheral arterial disease, glycated hemoglobin, infection, Wagner classification, and ulcer depth. All included studies had low concerns regarding applicability but exhibited high risk of bias, primarily due to insufficient events per variable, missing data, inadequate consideration of data complexity, lack of model performance assessment, and absence of internal validation.
Conclusion: Risk prediction model research for diabetic foot ulcer progression to amputation remains in its early stages. Future efforts should prioritize prospectively developing and externally validating models with robust performance and low bias, accompanied by rigorous internal validation and transparent reporting. (Funding: Natural Science Foundation of Hubei Province (2022CFB145) and Research Fund of Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology (2023D36)).
Keywords: diabetes foot, amputation, forecasting, models, systematic review