Construction of nomogram for wound recurrence in elderly patients with venous leg ulcers

Venous Leg Ulcers (VLUs) are one of the most serious and intractable complications of chronic venous insufficiency. This study aims to develop a nomogram based on a theoretical model to predict the probability of wound recurrence in older patients with VLUs.

The elderly patients with VLUs attending the five hospitals between September 2021 and October 2022 were enrolled in this research, and randomized to the training and validation cohorts based on the corresponding ratio (7:3). Recurrent events were recorded during a six-month follow-up after the baseline data collection. The univariate analysis, the least absolute shrinkage and selection operator (LASSO) regression method were used to screen variables, and multiple logistic regression was used to establish a risk prediction model, which was presented by nomogram. Receiver operating curves (ROC), Hosmer-Lemeshow test, as well as calibration curves, were adopted to assess the effectiveness of the nomogram. The prognostic value of the nomogram was also examined.

A total of 608 elderly patients with VLUs were included in the study. They were randomly divided into the training cohort (N = 421) and the validation cohort (N = 187). In the training cohort, Lasso regression and multivariate logistic regression analysis indicated that previous recurrence number, last ulcer duration, lower extremity DVT history, and frailty were independent risk factors for wound recurrence in elderly patients with VLUs, while daily exercise time and self-efficacy were protective factors. A nomogram was established with a good discrimination capacity and predictive efficiency with and the area under the curve (AUC) of 0.869 (95%CI: 0.831-0.908) in the training set and 0.890 (95%CI: 0.841-0.938) in the validation set. The p values of the Hosmer-Lemeshow test for both sets were 0.887 and 0.772, respectively, both greater than 0.05. The calibration degree charts showed that the data point connection was similar to the diagonal, indicating that the model's prediction probability of wound recurrence in elderly VLUs patients is close to the actual probability.

This study constructed a new nomogram to predict the risk of wound recurrence in elderly patients with VLUs. The nomogram has excellent accuracy and reliability, which can help healthcare workers and patients actively monitor and follow up with patients to prevent the recurrence of ulcers and make clinical decisions.