Cardiovascular/Stroke Risk Stratification in Diabetic Foot Infection Patients Using Deep Learning-Based Artificial Intelligence: An Investigative Study

Narendra N. Khanna, Mahesh A. Maindarkar, Vijay Viswanathan, Anudeep Puvvula, Sudip Paul, Mrinalini Bhagawati, Puneet Ahluwalia, Zoltan Ruzsa, Aditya Sharma, Raghu Kolluri, Padukone R. Krishnan, Inder M. Singh, John R. Laird, Mostafa Fatemi, Azra Alizad, Surinder K. Dhanjil, Luca Saba, Antonella Balestrieri, Gavino Faa, Kosmas I. ParaskevasDurga Prasanna Misra, Vikas Agarwal, Aman Sharma, Jagjit S. Teji, Mustafa Al-Maini, Andrew Nicolaides, Vijay Rathore, Subbaram Naidu, Kiera Liblik, Amer M. Johri, Monika Turk, David W. Sobel, Martin Miner, Klaudija Viskovic, George Tsoulfas, Athanasios D. Protogerou, Sophie Mavrogeni, George D. Kitas, Mostafa M. Fouda, Mannudeep K. Kalra, Jasjit S. Suri

Research output: Contribution to journalReview articlepeer-review


A diabetic foot infection (DFI) is among the most serious, incurable, and costly to treat conditions. The presence of a DFI renders machine learning (ML) systems extremely nonlinear, posing difficulties in CVD/stroke risk stratification. In addition, there is a limited number of well-explained ML paradigms due to comorbidity, sample size limits, and weak scientific and clinical validation methodologies. Deep neural networks (DNN) are potent machines for learning that generalize nonlinear situations. The objective of this article is to propose a novel investigation of deep learning (DL) solutions for predicting CVD/stroke risk in DFI patients. The Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA) search strategy was used for the selection of 207 studies. We hypothesize that a DFI is responsible for increased morbidity and mortality due to the worsening of atherosclerotic disease and affecting coronary artery disease (CAD). Since surrogate biomarkers for CAD, such as carotid artery disease, can be used for monitoring CVD, we can thus use a DL-based model, namely, Long Short-Term Memory (LSTM) and Recurrent Neural Networks (RNN) for CVD/stroke risk prediction in DFI patients, which combines covariates such as office and laboratory-based biomarkers, carotid ultrasound image phenotype (CUSIP) lesions, along with the DFI severity. We confirmed the viability of CVD/stroke risk stratification in the DFI patients. Strong designs were found in the research of the DL architectures for CVD/stroke risk stratification. Finally, we analyzed the AI bias and proposed strategies for the early diagnosis of CVD/stroke in DFI patients. Since DFI patients have an aggressive atherosclerotic disease, leading to prominent CVD/stroke risk, we, therefore, conclude that the DL paradigm is very effective for predicting the risk of CVD/stroke in DFI patients.

Original languageEnglish (US)
Article number6844
JournalJournal of Clinical Medicine
Issue number22
StatePublished - Nov 2022


  • AI bias
  • cardiovascular/stroke risk stratification
  • deep learning
  • diabetics
  • diabetic’s foot infection

ASJC Scopus subject areas

  • General Medicine


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