[Comparison of the predictive efficacy of the Wagner, SINBAD, and WIfI grading systems for short-term wound non-healing and amputation in patients with DFUs].
Xu Z, Duan W, et al. • Zhonghua shao shang yu chuang mian xiu fu za zhi • 2026
The SINBAD grading system performs best in predicting short-term wound non-healing in DFU patients, while the WIfI grading system has an advantage in predicting amputation, and all three grading systems can effectively predict both outcomes.
Key Findings
Results
Non-healing and amputation groups had significantly higher Wagner grades, SINBAD scores, and WIfI stages than their respective comparison groups.
400 patients with DFUs were enrolled from January 2023 to December 2024; 232 males and 168 females, aged 44 to 83 years.
Patients were assessed with all three grading systems within 48 hours of admission.
Non-healing group (206 cases) vs. healing group (194 cases): t values of 8.25, 19.78, and 9.87 for Wagner, SINBAD, and WIfI respectively (P<0.05).
Amputation group (255 cases) vs. non-amputation group (145 cases): t values of 14.05, 11.73, and 16.45 for Wagner, SINBAD, and WIfI respectively (P<0.05).
Results
The proportion of amputees and proportion of patients with non-healing wounds at 3 months differed significantly across different grades of all three grading systems.
Chi-square values for amputation proportions: 150.35 (Wagner), 133.84 (SINBAD), 187.63 (WIfI), all P<0.05.
Chi-square values for non-healing wound proportions: 73.97 (Wagner), 221.10 (SINBAD), 83.37 (WIfI), all P<0.05.
Results
Wagner grades, SINBAD scores, and WIfI stages were all significantly positively correlated with wound healing time in DFU patients.
Spearman correlation coefficients (rs): 0.52 for Wagner, 0.70 for SINBAD, and 0.52 for WIfI (all P<0.05).
SINBAD score showed the strongest correlation with wound healing time among the three systems.
Results
The SINBAD grading system had the highest predictive efficacy for short-term wound non-healing at 3 months after admission.
SINBAD AUROC: 0.96 (95% CI: 0.94–0.98), maximum Youden index: 0.80.
Wagner AUROC: 0.66 (95% CI: 0.61–0.72), maximum Youden index: 0.28.
WIfI AUROC: 0.69 (95% CI: 0.64–0.74), maximum Youden index: 0.33.
DeLong test confirmed SINBAD significantly superior to Wagner (Z=12.52, P<0.05) and to WIfI (Z=12.97, P<0.05).
Results
The WIfI grading system had the highest predictive efficacy for amputation in DFU patients, followed closely by the Wagner grading system.
WIfI AUROC: 0.89 (95% CI: 0.85–0.93), maximum Youden index: 0.75.
Wagner AUROC: 0.87 (95% CI: 0.83–0.91), maximum Youden index: 0.55.
SINBAD AUROC: 0.80 (95% CI: 0.76–0.84), maximum Youden index: 0.43.
DeLong test confirmed both WIfI (Z=3.76, P<0.05) and Wagner (Z=2.96, P<0.05) were significantly superior to SINBAD for predicting amputation.
Conclusions
All three grading systems can effectively predict short-term wound non-healing and amputation risk in DFU patients, with each system showing differential strengths.
SINBAD performs best for predicting short-term wound non-healing.
WIfI has an advantage in predicting amputation.
Wagner grading system shows poorer predictive efficacy for short-term wound non-healing but still demonstrates good predictive efficacy for amputation.
The authors recommend combining different grading systems in clinical practice based on the focus of assessment.
Xu Z, Duan W, Xie W, Tan Q, Fu X, Wang P, et al.. (2026). [Comparison of the predictive efficacy of the Wagner, SINBAD, and WIfI grading systems for short-term wound non-healing and amputation in patients with DFUs].. Zhonghua shao shang yu chuang mian xiu fu za zhi. https://doi.org/10.3760/cma.j.cn501225-20251129-00494