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

TL;DR

This study identifies key risk factors for mortality in hospitalized diabetic foot patients and creates a tool to predict 3-year survival.

Contribution

A novel nomogram is developed to predict 3-year mortality in diabetic foot ulcer patients based on renal and vascular factors.

Findings

The 3-year mortality rate was 49.3% among 485 hospitalized diabetic foot ulcer patients.

Renal impairment and peripheral artery disease severity were the strongest predictors of mortality.

The nomogram achieved strong predictive accuracy with a C-index of 0.79 and a 3-year AUC of 0.87.

Abstract

To evaluate mortality and risk factors in moderate-to-severe diabetic foot ulcer (DFU) hospitalized patients and develop a prognostic tool.

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.

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.

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.

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