Development and validation of an incidence risk prediction model for early foot ulcer in diabetes based on a high evidence systematic review and meta-analysis
Development and validation of an incidence risk prediction model for early foot ulcer in diabetes based on a high evidence systematic review and meta-analysis
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DOI：
10.1016/j.diabres.2021.109040
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发表时间：
2021-09-15
影响因子：
5.1
通讯作者：
Chang, Bai
中科院分区：
文献类型：
--
作者：
Chen, Dong;Wang, Meijun;Chang, Bai
目的：建立并验证基于系统评价和荟萃分析的早期糖尿病足溃疡（DFU）风险预测模型。方法：对DFU的危险因素及其相应的风险比（RR）进行meta分析。DFU预测模型包括meta分析中具有统计学意义的危险因素，所有危险因素均通过其权重评分，并使用来自中国的验证队列对预测模型进行外部验证。早期DFU的发生定义为基线时无DFU，随访时诊断为DFU的2型糖尿病患者。模型性能的评价基于识别受试者工作特征曲线（ROC）下的面积，通过计算灵敏度和特异性确定最佳截止点。采用Kaplan-Meier曲线比较不同组的累积风险。结果：我们的荟萃分析证实，46,521例糖尿病患者的累积发病率约为6.0%。最终的风险预测模型包括性别、BMI、HbA1c、吸烟者、DN、DR、DPN、间歇性跛行、足部护理，其rr分别为1.87、1.08、1.21、1.77、2.97、2.98、2.76、3.77、0.38。各危险因素按其权重相加得分为80分。预测模型判别良好，AUC = 0.798 （95% CI 0.738 ~ 0.858）。在最佳临界值为46.5点时，敏感性为0.769，特异性为0.798，约登指数为0.567。最终模型将验证队列分层为低、低中、高中和高风险组；与低危组比较，高、中危组发生DFU的RR （95% CI）分别为17.23 (5.12 ~ 58.02),p < 0.01; 46.11 (5.16 ~ 91.74), p < 0.01。结论：我们开发了一种基于评分的简单工具，可以帮助早期识别发生DFU的高风险糖尿病患者。这个简单的工具可以改善临床决策，并有可能指导早期干预。CO 2021 Elsevier B.V.版权所有
Objectives: To develop and validate a model for predicting the risk of early diabetic foot ulcer (DFU) based on systematic review and meta-analysis. Methods: Data were analyzed from the risk factors of DFU with their corresponding risk ratio (RR) by meta-analysis. The DFU prediction model included statistically significant risk factors from the meta-analysis, all of which were scored by its weightings, and the prediction model was externally validated using a validation cohort from China. The occurrence of early DFU was defined as patients with type 2 diabetes who were free of DFU at baseline and diagnosed with DFU at follow-up. Evaluation of model performance was based on the area under the discrimination receiver operating characteristic curve (ROC), with optimal cutoff point determined by calculation of sensitivity and specificity. Kaplan-Meier curve were performed to compare the cumulative risk of different groups. Results: Our meta-analysis confirmed a cumulative incidence of approximately 6.0% in 46,521 patients with diabetes. The final risk prediction model included Sex, BMI, HbA1c, Smoker, DN, DR, DPN, Intermittent Claudication, Foot care, and their RRs were 1.87, 1.08, 1.21, 1.77, 2.97, 2.98, 2.76, 3.77, 0.38, respectively. The total score of all risk factors was 80 points according to their weightings. The prediction model showed good discrimination with AUC = 0.798 (95 %CI 0.738-0.858). At the optimal cut-off value of 46.5 points, the sensitivity, specificity and Youden index were 0.769, 0.798 and 0.567, respectively. The final model stratified the validation cohort into low, low-intermediate, high-intermediate and high-risk groups; Compared with low-risk group, the RR with 95 %CI of developing DFU in high-intermediate and high-risk group were 17.23 (5.12-58.02), p < 0.01 and 46.11 (5.16- 91.74), p < 0.01, respectively. Conclusion: We have developed a simple tool to facilitates early identification of patients with diabetes at high risk of developing DFU based on scores. This simple tool may improve clinical decision-making and potentially guide early intervention. CO 2021 Elsevier B.V. All rights reserved.