Diabetic foot ulcers (DFUs) carry high risks of infection, major amputation, and death, creating a need for better short-term risk stratification during hospitalization. A retrospective cohort study published in Frontiers in Endocrinology evaluated the C-reactive protein-to-albumin ratio (CAR) and developed a nomogram to predict 6-month major adverse limb events (MALE) in hospitalized patients with DFUs.

The analysis included patients treated at a regional referral center in Northwest China between January 2020 and January 2025. Of 321 screened patients, 139 with complete data were included. MALE was defined as major amputation, unplanned limb revascularization, or death related to foot deterioration or progression of sepsis. Multivariable logistic regression and model performance analyses were performed.

During follow-up, 43 patients (31.0%) experienced MALE. CAR was independently associated with higher MALE risk (adjusted odds ratio [OR] 1.22; 95% confidence interval [CI] 1.03-1.48; P=0.033). Log-transformed ulcer area was also independently associated with MALE (adjusted OR 2.43; 95% CI 1.52-4.10; P<0.001). The model including CAR achieved an area under the receiver operating characteristic curve of 0.852 versus 0.827 for the base model, although this difference was not statistically significant by DeLong testing.

Adding CAR improved the Brier score and produced a positive integrated discrimination improvement. Bootstrap validation showed an optimism-corrected C-index of 0.831, and calibration remained acceptable. These findings suggest CAR may help refine 6-month limb risk assessment in hospitalized patients with DFUs, although external validation is needed before wider clinical use.