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DFU patients were divided into major amputation group and non-major amputation group, and nested case-control study method was used to identify case group and control group. The results of the first laboratory tests, imaging examinations, complications and other information of DFU patients at admission were collected, and initial predictive variables were selected. Logistic regression and LASSO regression in R software were used to develop a clinical prediction model for DFU patients with major amputation, which was displayed in the form of nomographs, and the model was evaluated by internal validation.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>A total of 3654 patients were diagnosed as DFU, 695 patients were included in the study on the development of risk prediction model of DFU major amputation, 139 patients in the case group and 556 patients in the control group. 9 variables (WBC, Hb, ALB, Wagner grade, amputation history, smoking, ABI\u2009&lt;\u20090.4, ulcer duration\u2009&gt;\u20091 month, HbA1c) screened by logistic regression and LASSO regression were used as predictors of major amputation in DFU patients. The internal validation showed that the C index adjusted by Bootstrap method was 0.91 (95% CI, 0.894\u20130.943), the average absolute error of the prediction model for drawing the calibration curve was 0.01, and the brier score was 0.08.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>The clinical risk prediction model of major amputation in DFU patients developed in this study has good discrimination and calibration, can accurately predict the outcome events, can be used as an effective tool to guide doctors to make clinical decisions, and enrich and improve the content of DFU prevention and control work, but the promotion and use of the model still needs further verification of external data.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Clinical trial number<\/jats:title>\n                    <jats:p>Not applicable.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1186\/s12902-026-02215-z","type":"journal-article","created":{"date-parts":[[2026,3,5]],"date-time":"2026-03-05T09:46:06Z","timestamp":1772703966000},"update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":1,"title":["Development of risk prediction model for major amputation in patients with diabetic foot"],"prefix":"10.1186","volume":"26","author":[{"given":"Qingwei","family":"Lu","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Xiaolu","family":"Wei","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Wangao","family":"Zhang","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jun","family":"Wang","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2026,3,5]]},"reference":[{"key":"2215_CR1","doi-asserted-by":"publisher","first-page":"305","DOI":"10.1111\/dom.12190","volume":"16","author":"I U\u00e7kay","year":"2014","unstructured":"U\u00e7kay I, Gariani K, Pataky Z, et al. 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The study has been approved by the Ethics Committee of the First Teaching Hospital of Tianjin University of Traditional Chinese Medicine (TYLL2017 [K] word 024). In the whole process, the research object data should be kept confidential, and should not be disclosed without the permission of the relevant units and patients themselves. The clinical data collected and sorted out are limited to the use of this study. Informed consent has been obtained from all the participants. Also, legal guardians of the illiterate participants provided a written informed consent and verbal informed consent was obtained directly from the illiterate participants themselves.","order":2,"name":"Ethics","group":{"name":"EthicsHeading","label":"Ethics approval and consent to participate"}},{"value":"Not applicable.","order":3,"name":"Ethics","group":{"name":"EthicsHeading","label":"Consent for publication"}},{"value":"The authors declare no competing interests.","order":4,"name":"Ethics","group":{"name":"EthicsHeading","label":"Competing interests"}}],"article-number":"105"}}