Development and Validation of a Nursing-Integrated Nomogram to Predict 1-Year Ulcer Recurrence in Patients with...

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.

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.

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).

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%.

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.