Establishment of a nomogram predictive model based on serum leptin-to-adiponectin ratio for cognitive frailty in elderly patients with type 2 diabetes mellitus

WANG Zhongjun; CHEN Jinyi; LI Minxiang

doi:10.3969/j.issn.1002-266X.2023.34.007

Abstract：Objective To observe the changes of serum leptin(LEP)and adiponectin(APN)levels in elderly pa-tients with type 2 diabetes mellitus(T2DM)complicated with cognitive frailty(CF),to establish a nomogram predictive model based on serum LEP-to-APN(L/A)ratio for CF in elderly patients with T2DM and to predict its value.Methods A total of 321 elderly patients with T2DM were enrolled as the research objects(observation group),and patients were di-vided into the CF group and non-CF group according to whether CF occurred.In addition,100 healthy people undergoing physical examination during the same period were selected as the control group.Serum levels of LEP,APN,and L/A ratio between the observation group and the control group,and the demographic,clinical data,and the serum levels of LEP,APN,and L/A ratio between the CF group and non-CF group were compared.Multivariate Logistic regression model was used to analyze the independent risk factors for concurrent CF in elderly patients with T2DM.The receiver operating char-acteristic(ROC)curve was drawn to evaluate the predictive value of L/A ratio for concurrent CF in elderly patients with T2DM.A nomogram predictive model based on L/A ratio for concurrent CF in elderly patients with T2DM was estab-lished,and internal validation was conducted.Results Compared with the control group,the serum LEP level and the L/A ratio increased significantly,and the serum APN level decreased in the observation group(Z=-7.723,-6.404,-9.145,all P<0.05).Of 321 elderly patients with T2DM,85 cases had CF,with an incidence of 26.48%.Multivariate Logistic regression analysis showed that age≥75 years,depression,malnutrition,the elevated level of HbA1c and L/A ra-tio were independent risk factors for concurrent CF in elderly patients with T2DM(all P<0 05).According to the ROC curve analysis,the area under the curve(AUC),specificity,sensitivity and optimal cut-off value of L/A ratio in predict-ing the concurrent CF in elderly patients with T2DM were 0.798(95%CI:0.750-0.840),85.59%,65.88%and 1.18,respectively.The nomogram prediction model based on L/A ratio constructed by the above five risk factors dis-played good discrimination with a C-index of 0.853(95%CI:0.809-0.897).The calibration curve showed that the pre-dicted probability of the model was close to the actual probability and had good consistency.According to decision curve analysis,when the threshold was 0.1-0.8,the nomogram prediction model had good clinical practicality.Conclusions L/A ratio increases in elderly patients with T2DM,and it is an independent risk factor for concurrent CF in elderly pa-tients with T2DM.L/A ratio has a certain value in predicting concurrent CF in elderly patients with T2DM,and the nomo-gram prediction model based on L/A ratio has a high predictive ability for concurrent CF in elderly patients with T2DM.