Establishment Of Prediction Model For Acute Renal Injury Following Tibial Transverse Transport In Patients With Diabetic Foot

Objective:To analyze the independent risk factors of acute kidney injury（AKI）after tibial transverse transport（TTT）in patients with diabetic foot,to establish a prediction model for AKI following TTT.Methods:The clinical data of diabetic foot patients undergoing TTT surgery in our hospital from July 2014 to December 2019 were retrospectively analyzed.Patients were divided into AKI group and non-AKI group according to whether AKI occurred after surgery.Use R3.6.1 and SPSS 22.0 for statistical analysis,compare the clinical data of the two groups,select independent risk factors for AKI in patients through univariate analysis and logistic regression analysis,establish a logistic regression prediction model,draw a Nomogram model,use a calibration curve And the Hosmer-Lemeshow tests its calibration,and use receiver operating characteristic（ROC）curve to test its discrimination.Results:Among the 254 patients,42 cases（16.5%）developed AKI after operation.Multivariate Logistic regression analysis showed preoperative complications of diabetic retinopathy（OR=2.392,95%CI 1.034～5.531,P=0.041）,randomized urinary albumin/creatinine ratio（u ACR）（OR=1.005,95%CI1.001～1.008,P=0.022）,cystatin C（Cys C）（OR=3.208,95%CI 1.535～6.704,P=0.002）,25-Hydroxyvitamin D3 less than 47nmol/L（OR=2.740,95%CI1.247～6.024,P=0.012）,and hyperhomocysteinemia（OR=3.536,95%CI1.473～8.488,P=0.005）are independent risk factors for AKI following TTT.The risk prediction equation and Nomogram model of AKI following TTT in diabetic foot patients were established.The risk prediction equation is Y=-4.426+0.872X₁+0.005X₂+1.166X₃+1.008X₄+1.263X₅（X1 means diabetic retinopathy,X₂ means u ACR,X₃ means Cys C,X₄ means 25-Hydroxyvitamin D3less than 47nmol/L,X₅ means hyperhomocysteinemia）.The calibration curve of this research model is basically located near the standard curve.Hosmer-Lemeshow test P=0.383,area under ROC curve=0.820,sensitivity is 0.952,and specificity is 0.561,which indicates that the research model has good calibration and discrimination,and has definite clinical application value.Conclusion:Diabetic retinopathy,u ACR,Cys C,25-Hydroxyvitamin D3less than 47nmol/L,hyperhomocysteinemia are independent risk factors for AKI following TTT in patients with diabetic foot.The prediction model based on the above independent risk factors can help predict the risk of AKI following TTT.