What question did this study set out to answer?

To develop and validate a nomogram that utilizes nursing and clinical indicators to predict the risk of ulcer recurrence in diabetic foot ulcer patients after endovascular therapy.

April 24, 2026Open Access

Development and Validation of a Nursing-Integrated Nomogram to Predict 1-Year Ulcer Recurrence in Patients with Diabetic Foot Ulcers After Endovascular Therapy

Key Points

To develop and validate a nomogram that utilizes nursing and clinical indicators to predict the risk of ulcer recurrence in diabetic foot ulcer patients after endovascular therapy.
Conducted a retrospective cohort study with 568 diabetic foot ulcer patients who underwent endovascular therapy.
Divided patients into training (n=398) and validation cohorts (n=170) to develop and test the nomogram.
Used LASSO regression and multivariable logistic regression to identify predictors and create the nomogram.
Identified a 1-year ulcer recurrence rate of 34.2% among patients.
Five independent predictors of recurrence were established, including HbA1c and social support scores.
The nomogram demonstrated excellent predictive ability with a C-index of 0.842 in training and 0.815 in validation cohorts.

Abstract

Background: Endovascular therapy (EVT) has become the first-line treatment for ischemic diabetic foot ulcers (DFU). However, the rate of ulcer recurrence within one year remains high, leading to repeat hospitalizations and amputations. Current prognostic models primarily focus on vascular patency and biological markers, largely overlooking the critical influence of nursing assessments, patient self-care behaviors, and social support systems. Objective: To construct and validate a novel nomogram that integrates clinical indicators with nursing assessment variables to predict the risk of 1-year ulcer recurrence in DFU patients following successful EVT. Methods: A retrospective cohort study was conducted involving 568 DFU patients who underwent successful EVT at a tertiary center between January 2020 and December 2024. Patients were randomized into a training cohort (n=398) and a validation cohort (n=170). Predictors included demographics, clinical markers, and nursing assessments (Exercise of Self-Care Agency ESCA scale, Off-loading Adherence, Social Support Rating Scale SSRS). Least Absolute Shrinkage and Selection Operator (LASSO) regression and multivariable logistic regression were used for model construction. The model was visualized as a nomogram and evaluated using the C-index, calibration plots, and Decision Curve Analysis (DCA). Results: The 1-year recurrence rate was 34.2% (194/568). Five independent predictors were identified: HbA1c (OR 1.32), WIfI stage (OR 2.05), ESCA score (OR 0.93), Poor Off-loading Adherence (OR 3.12), and Social Support Score (OR 0.89). The nursing-integrated nomogram showed excellent discrimination with a C-index of 0.842 (95% CI: 0.805– 0.879) in the training cohort and 0.815 (95% CI: 0.762– 0.868) in the validation cohort. Calibration plots demonstrated good agreement. DCA indicated significant net clinical benefit across threshold probabilities of 10% to 75%. Conclusion: Integrating nursing assessment indicators with clinical data significantly improves the prediction of DFU recurrence. This nomogram provides a practical tool for nurses to identify high-risk patients at discharge, facilitating targeted behavioral interventions to improve long-term limb salvage outcomes. Keywords: diabetic foot ulcer, recurrence, nomogram, nursing assessment, self-care agency, endovascular therapy

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Cite This Study

傅力 et al. (Wed,) studied this question.

synapsesocial.com/papers/69eb099a553a5433e34b3f7b https://doi.org/https://doi.org/10.2147/dmso.s591186

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