# Development of an XGBoost-based prediction model for wound recurrence risk in diabetic foot ulcer patients treated with antibiotic-loaded bone cement

## TL;DR

This study develops an XGBoost-based model to predict wound recurrence risk in diabetic foot patients treated with antibiotic-loaded bone cement, aiming to improve surgical outcomes.

## Contribution

The novel contribution is the development and validation of the PRL-XGBoost model for predicting diabetic foot ulcer recurrence after antibiotic bone cement treatment.

## Key findings

- The PRL-XGBoost model achieved an AUC of 0.85 in training and 0.71 in testing, indicating strong predictive performance.
- The model's PR-AUC of 0.97 suggests resistance to overfitting and practical applicability.
- Key predictors include γ-glutamyl transpeptidase, lipoprotein A, peripheral vascular disease, peripheral neuropathy, and white blood cells.

## Abstract

This study aims to improve the surgical cure rate, develop interventions to reduce the incidence of postoperative nonunion or recurrence of diabetic foot wounds, and formulate an optimal prediction model to quantify the predictive risk value of antibiotic bone-cement failure in the treatment of diabetic foot.

The training and test sets were created once the cases were collected. Based on feature correlation, feature importance, and feature weight, LASSO analysis, random forest, and the Pearson correlation coefficient approach were used to identify the features. Artificial neural network, support vector machine, and XGBoost prediction models were built according to the selected optimal features. The receiver operating characteristic curve, precision–recall (PR) curve, and decision curve analysis were utilized to validate the performance of the models and select the optimal prediction model. Lastly, an independent test set was created to assess and determine the best model’s capacity for generalization.

A comparative analysis revealed that the area under the curve (AUC) for the training set of the PRL-XGBoost prediction model was 0.85 and that for the test set was 0.71. This finding suggests that the model exhibits good predictive ability. Moreover, the PR-AUC value of the prediction model was 0.97, indicating that it demonstrates good resistance to overfitting. Additionally, the DCA curve showed that the PRL-XGBoost prediction model has significant application value and practicality. Therefore, PRL-XGBoost was found to be the most effective prediction model.

The findings from this study prove that γ-glutamyl transpeptidase, lipoprotein A, peripheral vascular disease, peripheral neuropathy, and white blood cells are the key indices that affect the surgical outcome. These parameters determine the nutritional and immune status of the lower limb endings, leading to ulceration, infection, and nonunion of the diabetic foot. Hence, the PRL-XGBoost prediction model can be applied for the preoperative evaluation and screening of patients with diabetic foot treated with antibiotic bone cement, resulting in favorable clinical outcomes.