Mortality predictors and survival nomogram for hospitalized diabetic foot patients: a decade-long cohort

Objectives: To evaluate mortality and risk factors in moderate-to-severe diabetic foot ulcer (DFU) hospitalized patients and develop a prognostic tool. Methods: This cohort study enrolled 485 eligible DFU patients (2009-2014), followed through 2024. Mortality was analyzed using Cox regression and Kaplan-Meier methods, focusing on peripheral artery disease (PAD) and other risk factors (p<0.05). A nomogram predicting 3-year mortality was developed based on multivariate Cox analysis. Results: The 3-year all-cause mortality rate in this cohort of 485 diabetic foot ulcer patients was 49.3%. The two most salient predictors of mortality were renal impairment and PAD severity. Patients requiring dialysis had a 3.05-fold increased risk of death, while the risk escalated sharply with PAD severity, reaching a 3.57-fold increase for severe PAD. The prognostic nomogram, which integrated these key factors, demonstrated strong predictive accuracy for 3-year survival, with a C-index of 0.79 and a 3-year AUC of 0.87. Conclusions: Hospitalized patients with moderate-to-severe diabetic foot show high mortality, predominantly associated with dialysis, CKD, and PAD. The developed nomogram effectively predicts 3-year mortality risk.