1
|
Nomura T, Shoji K, Kitamura M, Yoshida S, Ono K, Wada N, Keira N, Tatsumi T. Impact of Controlling Nutritional Status Score on Comprehensive Clinical Outcomes in Patients With Chronic Limb-Threatening Ischemia in a Local Area of Super-Aged Society. J Endovasc Ther 2024:15266028241259396. [PMID: 38887033 DOI: 10.1177/15266028241259396] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/20/2024]
Abstract
PURPOSE This study aimed to evaluate the relationship between nutritional status and hospital outcomes in patients with chronic limb-threatening ischemia (CLTI) in a local area of contemporary super-aged society of Japan. MATERIALS AND METHODS We analyzed 131 consecutive patients with 179 lower limb diseases admitted to our hospital for the treatment of CLTI between April 2018 and March 2023. These 131 patients were divided into 3 groups according to hospital outcomes: home discharge (HD), out-of-home discharge (OD), and in-hospital death (ID). Patient and lesion backgrounds were compared among the 3 groups, and a multivariable regression analysis was used to analyze the interaction between malnutrition and composite hard endpoints. RESULTS The median age was 82.8 years, and non-ambulatory patients comprised 61.8% of the study population. The HD group included more ambulatory and fewer patients with higher CONUT score or inflammation than OD or ID group. The Rutherford classification and Wound, Ischemia, and foot Infection stage were significantly more severe in the ID group than in the HD group. Endovascular treatment (EVT) was more often implemented in the HD (94.9%) and OD (81.7%) groups than in the ID group (60.0%). However, all EVT procedures in the ID group were performed until as distally as possible to achieve the target arterial path success contrary to some EVT procedures in the HD or ID group that targeted lesions only above the knee. Multivariate analysis showed that a non-ambulatory state (hazard ratio [HR]=3.65, 95% confidence interval [CI]=1.48-9.02) and a higher controlling nutritional status (CONUT) score (≥5) (HR=7.46, 95% CI=1.66-33.6) were significant predictors for composite endpoints (major amputation or ID). Patients with lower CONUT scores (≤4) showed better outcomes in all indices including overall survival, major amputation-free survival, and wound healing. CONCLUSION Condition of the CLTI patients represented by higher CONUT score emerged as the most influential predictor of major amputation or ID. Furthermore, non-ambulatory status or condition of higher CONUT score affects the destination after discharge. Implementing multidisciplinary approaches to address patients' nutritional state and physical disability, in addition to revascularization, may enhance comprehensive prognoses in patients with CLTI. CLINICAL IMPACT In this single-center retrospective study, we analyzed prognoses of 131 consecutive patients with 179 lower limb diseases admitted for the treatment of chronic limb-threatening ischemia (CLTI) between April 2018 and March 2023. Our main finding was that condition of the CLTI patients represented by higher controlling nutritional status (CONUT) score was the most significant predictor of either major amputation or in-hospital death. Furthermore, condition of higher CONUT score or non-ambulatory status affects the destination after discharge. This suggests that multidisciplinary approaches to address patients' nutritional state and physical disability, in addition to revascularization, may enhance the prognosis in patients with CLTI. This is the first report to evaluate nutritional status associated with comprehensive hospital outcomes in addition to previously reported hard endpoints, such as major amputation or overall survival, and will be of great help in future clinical practice.
Collapse
Affiliation(s)
- Tetsuya Nomura
- Department of Cardiovascular Medicine, Kyoto Chubu Medical Center, Nantan, Japan
| | - Keisuke Shoji
- Department of Cardiovascular Medicine, Kyoto Chubu Medical Center, Nantan, Japan
| | - Michitaka Kitamura
- Department of Cardiovascular Medicine, Kyoto Chubu Medical Center, Nantan, Japan
| | - Shiori Yoshida
- Department of Cardiovascular Medicine, Kyoto Chubu Medical Center, Nantan, Japan
| | - Kenshi Ono
- Department of Cardiovascular Medicine, Kyoto Chubu Medical Center, Nantan, Japan
| | - Naotoshi Wada
- Department of Cardiovascular Medicine, Kyoto Chubu Medical Center, Nantan, Japan
| | - Natsuya Keira
- Department of Cardiovascular Medicine, Kyoto Chubu Medical Center, Nantan, Japan
| | - Tetsuya Tatsumi
- Department of Cardiovascular Medicine, Kyoto Chubu Medical Center, Nantan, Japan
| |
Collapse
|
2
|
McGinigle KL, Spangler EL, Ayyash K, Arya S, Settembrini AM, Thomas MM, Dell KE, Swiderski IJ, Davies MG, Setacci C, Urman RD, Howell SJ, Garg J, Ljungvist O, de Boer HD. A framework for perioperative care for lower extremity vascular bypasses: A Consensus Statement by the Enhanced Recovery after Surgery (ERAS®) Society and Society for Vascular Surgery. J Vasc Surg 2023; 77:1295-1315. [PMID: 36931611 DOI: 10.1016/j.jvs.2023.01.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2022] [Revised: 12/30/2022] [Accepted: 01/03/2023] [Indexed: 03/17/2023]
Abstract
The Society for Vascular Surgery and the Enhanced Recovery After Surgery (ERAS) Society formally collaborated and elected an international, multi-disciplinary panel of experts to review the literature and provide evidence-based suggestions for coordinated perioperative care for patients undergoing infrainguinal bypass surgery for peripheral artery disease. Structured around the ERAS core elements, 26 suggestions were made and organized into preadmission, preoperative, intraoperative, and postoperative sections.
Collapse
Affiliation(s)
- Katharine L McGinigle
- Department of Surgery, School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC.
| | - Emily L Spangler
- Department of Surgery, School of Medicine, University of Alabama at Birmingham, Birmingham, AL
| | - Katie Ayyash
- Department of Perioperative Medicine (Merit), York and Scarborough Teaching Hospitals NHS Foundation Trust, York, United Kingdom
| | - Shipra Arya
- Department of Surgery, School of Medicine, Stanford University, Palo Alto, CA
| | | | - Merin M Thomas
- Lenox Hill Hospital, Northwell Health, New Hyde Park, NY
| | | | | | - Mark G Davies
- Department of Surgery, Joe R. & Teresa Lozano Long School of Medicine, University of Texas Health Sciences Center, San Antonio, TX
| | - Carlo Setacci
- Department of Surgery Surgery, University of Siena, Siena, Italy
| | - Richard D Urman
- Department of Anesthesiology, Perioperative and Pain Medicine, Brigham and Women's Hospital, Boston, MA
| | - Simon J Howell
- Leeds Institute of Medical Research at St. James's, University of Leeds, Leeds, United Kingdom
| | - Joy Garg
- Department of Vascular Surgery, Kaiser Permanente San Leandro, San Leandro, CA
| | - Olle Ljungvist
- Department of Surgery, Orebro University, Orebro, Sweden
| | - Hans D de Boer
- Department of Anesthesiology, Pain Medicine, and Procedure Sedation and Analgesia, Martini General Hospital Groningen, Groningen, the Netherlands
| |
Collapse
|
3
|
Kobayashi T, Hamamoto M, Okazaki T, Tomota M, Fujiwara T, Hasegawa M, Takahashi S. Effectiveness of the Vascular Quality Initiative Chronic Limb-Threatening Ischemia Mortality Prediction Model in Patents with Distal Bypass. Ann Vasc Surg 2023; 90:188-196. [PMID: 36442707 DOI: 10.1016/j.avsg.2022.10.021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2022] [Revised: 10/12/2022] [Accepted: 10/27/2022] [Indexed: 11/27/2022]
Abstract
BACKGROUND The purpose of this study is to evaluate the effectiveness of mortality prediction using the Vascular Quality Initiative (VQI) chronic limb-threatening ischemia (CLTI) model in patients with distal bypass. METHODS Patients who underwent distal bypass for CLTI from 2009 to 2020 at a single center were retrospectively reviewed. Distal bypass was defined as any bypass with a distal anastomosis to the posterior tibial, anterior tibial, dorsalis pedis, plantar, or peroneal artery. Baseline characteristics, operative details, hospital outcomes, and medium-term outcomes were compared among patients with a low-, medium-, and high-risk of mortality based on a VQI CLTI calculation. The primary endpoints were survival and limb salvage. RESULTS A total of 287 distal bypasses were performed in 230 patients (153 males; median age, 74 years; diabetes mellitus, 70%; end-stage renal disease [ESRD] with hemodialysis, 38%). These patients were stratified into 153 (66%) low-, 35 (15%) medium-, and 42 (18%) high-risk cases based on the VQI CLTI model. There were two hospital deaths (1%) within 30 days. During a mean follow-up period of 33 ± 29 months, 105 patients died and 26 limbs (9%) required major amputation. The 2-year survival rate of 81% in the low-risk group was significantly higher than those of 41% in the medium-risk group and 46% in the high-risk group (both P < 0.001). The 2-year survival rates did not differ significantly between the medium- and high-risk groups (P = 0.81). The 2-year limb salvage rate of 93% in the low-risk group was significantly higher than those of 81% in the medium-risk (P = 0.023) and those of 87% in the high-risk (P = 0.039) groups. There were no significant differences in graft patency and wound healing among the three groups. CONCLUSIONS These results suggest that distal bypass is optimal treatment for patients with a low VQI-predicted risk of mortality. However, the lower limb salvage and higher mortality rates at 2 years suggest that the decision-making for VQI medium- and high-risk patients may be carefully considered.
Collapse
Affiliation(s)
- Taira Kobayashi
- Department of Cardiovascular Surgery, JA Hiroshima General Hospital, Hiroshima, Japan.
| | - Masaki Hamamoto
- Department of Cardiovascular Surgery, JA Hiroshima General Hospital, Hiroshima, Japan
| | - Takanobu Okazaki
- Department of Cardiovascular Surgery, JA Hiroshima General Hospital, Hiroshima, Japan
| | - Mayu Tomota
- Department of Cardiovascular Surgery, JA Hiroshima General Hospital, Hiroshima, Japan
| | - Takashi Fujiwara
- Department of Cardiology, JA Hiroshima General Hospital, Hiroshima, Japan
| | - Misa Hasegawa
- Department of Reconstructive and Plastic Surgery, JA Hiroshima General Hospital, Hiroshima, Japan
| | - Shinya Takahashi
- Department of Cardiovascular Surgery, Hiroshima University, Hiroshima, Japan
| |
Collapse
|
4
|
Liu G, Zou C, Jie Y, Wang P, Wang X, Fan Y. Predictive Value of Geriatric Nutritional Risk Index in Patients With Lower Extremity Peripheral Artery Disease: A Meta-Analysis. Front Nutr 2022; 9:903293. [PMID: 35811972 PMCID: PMC9257164 DOI: 10.3389/fnut.2022.903293] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2022] [Accepted: 05/16/2022] [Indexed: 11/21/2022] Open
Abstract
Background Conflicting results have been reported on the value of the Geriatric Nutritional Risk Index (GNRI) in predicting adverse outcomes in patients with peripheral artery disease (PAD). The objective of this meta-analysis was to evaluate the association of GNRI with adverse outcomes in patients with lower extremity PAD. Methods Relevant studies were comprehensively searched in PubMed and Embase databases until December 31, 2021. Eligible studies should evaluate the value of GNRI in predicting major adverse cardiovascular and leg events (MACLEs), all-cause mortality, and amputation in patients with lower extremity PAD. Results Eight studies reporting on 9 articles involving 5,541 patients were included. A fixed-effect model meta-analysis showed that patients with PAD with low GNRI had an increased risk of MACLEs [adjusted risk ratio (RR) 2.26; 95% confidence interval (CI) 1.54–3.31] and all-cause mortality (RR 2.38; 95% CI 1.71–3.31) compared with those with high GNRI. When analysis of GNRI is by continuous data, 10 units of GNRI decrease was associated with 36% and 44% higher risk of MACLEs and all-cause mortality, respectively. However, per 10 units GNRI score decrease was not significantly associated with a higher risk of amputation (p = 0.051). Conclusion Low GNRI may be an independent predictor of adverse outcomes in patients with lower extremity PAD. Routine screening of nutritional status using the GNRI may provide important prognostic information in patients with PAD.
Collapse
Affiliation(s)
- Guodong Liu
- Department of General Surgery, The Suqian Clinical College of Xuzhou Medical University, Suqian, China
| | - Chen Zou
- Cancer Institute, The Affiliated People's Hospital, Jiangsu University, Zhenjiang, China
| | - Yu Jie
- Cancer Institute, The Affiliated People's Hospital, Jiangsu University, Zhenjiang, China
| | - Pei Wang
- Cancer Institute, The Affiliated People's Hospital, Jiangsu University, Zhenjiang, China
| | - Xiaoyan Wang
- Department of Gastroenterology, The Suqian Clinical College of Xuzhou Medical University, Suqian, China
- Xiaoyan Wang
| | - Yu Fan
- Cancer Institute, The Affiliated People's Hospital, Jiangsu University, Zhenjiang, China
- *Correspondence: Yu Fan
| |
Collapse
|
5
|
Rodighiero J, Léveillé N, Shen S, Ekmekjian T, Ades M, Drudi LM. A scoping review of malnutrition in patients undergoing interventions for peripheral arterial disease. J Vasc Surg 2022; 76:1742-1754.e3. [PMID: 35709852 DOI: 10.1016/j.jvs.2022.04.044] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2021] [Revised: 03/28/2022] [Accepted: 04/15/2022] [Indexed: 11/16/2022]
Abstract
BACKGROUND Peripheral arterial disease (PAD) is associated with comorbid conditions and frailty. The role of pre-operative nutrition in these patients with PAD is not well characterized. This scoping review sought to describe the prevalence and prognostic implications of pre-operative malnutrition in patients undergoing vascular interventions for claudication or critical limb threatening ischemia (CLTI). METHODS Studies were systematically searched across 6 databases from inception to August 2021. Studies focusing on patients with claudication or CLTI undergoing open or endovascular procedures were included if pre-operative nutrition was measured and correlated with a clinical outcome. RESULTS Of 4186 records identified, 24 studies addressed the prevalence or prognostic impact of malnutrition in patients undergoing interventions for PAD. The proportion of women included in these studies ranged from 6% to 58%. The prevalence of pre-operative malnutrition ranged from 14.6% to 72%, and notably 7 different malnutrition assessments were used in these studies. Across all scales, pre-operative malnutrition was associated with at least one of the following outcomes: mortality, post-operative complications, length of stay, readmission rates, as well as delayed wound healing. CONCLUSION There are a variety of tools used to measure malnutrition in patients undergoing interventions for PAD. Our findings suggest that pre-operative malnutrition is associated with adverse clinical outcomes in patients undergoing open and endovascular procedures for claudication or CLTI, and there is lack of consensus on which tool to use. Clinicians and surgeons should be sensitized to the importance of assessing malnutrition preoperatively in adults undergoing interventions for PAD.
Collapse
Affiliation(s)
| | - Nayla Léveillé
- Faculté de médecine de l'Université de Montréal, Montreal, QC, Canada
| | - Shiyang Shen
- Faculty of Medicine, McGill University, Montreal, QC, Canada
| | - Taline Ekmekjian
- Medical Library, McGill University Health Centre, Montreal, QC, Canada
| | - Matthew Ades
- Department of Medicine, Division of General Internal Medicine, McGill Univeristy, Montreal, QC, Canada
| | - Laura M Drudi
- Division of Vascular Surgery, Centre Hospitalier de l'Université de Montréal, Montreal, QC, Canada; Centre de recherche du Centre Hospitalier de L'Université de Montréal (CRCHUM), Montreal, QC, Canada.
| |
Collapse
|
6
|
Kobayashi T, Hamamoto M, Okazaki T, Tomota M, Fujiwara T, Hasegawa M, Takahashi S. An evaluation of preoperative nutritional assessment methods in patients with chronic limb-threatening ischemia with distal bypass. Eur J Vasc Endovasc Surg 2022; 64:92-100. [DOI: 10.1016/j.ejvs.2022.03.037] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2021] [Revised: 03/08/2022] [Accepted: 03/25/2022] [Indexed: 11/03/2022]
|
7
|
Kodama A, Komori K, Koyama A, Sato T, Ikeda S, Tsuruoka T, Kawai Y, Niimi K, Sugimoto M, Banno H, Nishida K. Impact of Serum Zinc Level and Oral Zinc Supplementation on Clinical Outcomes in Patients Undergoing Infrainguinal Bypass for Chronic Limb-Threatening Ischemia. Circ J 2022; 86:995-1006. [PMID: 35342125 DOI: 10.1253/circj.cj-21-0832] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
BACKGROUND Zinc (Zn) has been reported to play an important role in wound healing (WH). Nevertheless, the effect of Zn in chronic limb-threatening ischemia (CLTI) patients is unclear. This study investigated the effect of Zn on the clinical outcomes of CLTI patients undergoing bypass surgery.Methods and Results:This study reviewed 111 consecutive patients who underwent an infrainguinal bypass from 2012 to 2020. Patients with Zn deficiency (serum Zn level <60 μg/dL) received oral Zn supplementation and maintained a normal level until WH. This study aimed to explore: (1) the effect of Zn deficiency; and (2) Zn supplementation in Zn-deficient patients on the clinical outcomes of this cohort. Patients with Zn deficiency, Zn supplementation, and no Zn supplementation despite Zn deficiency accounted for 48, 21, and 42 patients, respectively. (1) Zn deficiency was associated with WH (HR, 0.47; 95% CI, 0.29-0.78: P=0.003), major adverse limb events (MALE) (HR, 2.53; 95% CI, 1.26-5.09: P=0.009), and major amputation or death (HR, 3.17; 95% CI, 1.51-6.63: P=0.002). (2) Zn supplementation was positively related to WH (HR, 2.30; 95% CI, 1.21-4.34: P=0.011). This result was confirmed using propensity score matching (HR, 2.24; 95% CI, 1.02-4.87: P=0.043). CONCLUSIONS The current study revealed that Zn level was associated with clinical outcomes in CLTI patients after bypass surgery. Oral Zn supplementation could improve WH in these patients.
Collapse
Affiliation(s)
- Akio Kodama
- Division of Vascular and Endovascular Surgery, Department of Surgery, Nagoya University School of Medicine
| | - Kimihiro Komori
- Division of Vascular and Endovascular Surgery, Department of Surgery, Nagoya University School of Medicine
| | - Akio Koyama
- Department of Vascular Surgery, Ichinomiya Municipal Hospital
| | - Tomohiro Sato
- Division of Vascular and Endovascular Surgery, Department of Surgery, Nagoya University School of Medicine
| | - Shuta Ikeda
- Division of Vascular and Endovascular Surgery, Department of Surgery, Nagoya University School of Medicine
| | - Takuya Tsuruoka
- Division of Vascular and Endovascular Surgery, Department of Surgery, Nagoya University School of Medicine
| | - Yohei Kawai
- Division of Vascular and Endovascular Surgery, Department of Surgery, Nagoya University School of Medicine
| | - Kiyoaki Niimi
- Division of Vascular and Endovascular Surgery, Department of Surgery, Nagoya University School of Medicine
| | - Masayuki Sugimoto
- Division of Vascular and Endovascular Surgery, Department of Surgery, Nagoya University School of Medicine
| | - Hiroshi Banno
- Division of Vascular and Endovascular Surgery, Department of Surgery, Nagoya University School of Medicine
| | - Kazuki Nishida
- Biostatistics and Bioinformatics Section, Center for Advanced Medicine and Clinical Research, Nagoya University Hospital
| |
Collapse
|
8
|
Adegbola A, Behrendt CA, Zyriax BC, Windler E, Kreutzburg T. The impact of nutrition on the development and progression of peripheral artery disease: A systematic review. Clin Nutr 2021; 41:49-70. [PMID: 34864455 DOI: 10.1016/j.clnu.2021.11.005] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2021] [Revised: 10/16/2021] [Accepted: 11/04/2021] [Indexed: 11/26/2022]
Abstract
BACKGROUND & AIMS This systematic review sought to identify and summarize existing evidence for the impact of nutrition on the development, progression, and outcomes of peripheral artery disease (PAD). METHODS We performed a systematic literature search of available studies published between January 1974 and December 2019. Randomized controlled trials (RCT), observational studies, and cross-sectional studies reporting either the primary or secondary prevention of PAD with nutritional intake were included. The quality assessment was performed for the RCTs, without pooling a meta-risk estimate. RESULTS Among a total of 8502 records screened, 186 full texts were assessed for eligibility, and 82 studies (30% RCT) were analyzed. The nutrients were structured in fruits, vegetables and antioxidants, fats and oils, dietary fiber, meat, proteins, vitamins and trace elements, and diets and lifestyle. The findings of the current systematic review indicate that the Mediterranean diet, nuts, and polyunsaturated fat are associated with a lower incidence of PAD and saturated fat, cholesterol, and processed meat were associated with higher rates of cardiovascular events in patients suffering from PAD. CONCLUSIONS The current review found evidence of a beneficial impact of the Mediterranean diet including nuts in this target population. More RCTs and high-quality registries are needed that focus on nutritional habits among patients with PAD to design appropriate preventive programs.
Collapse
Affiliation(s)
- Abiodun Adegbola
- Department of Vascular Medicine, Research Group GermanVasc, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.
| | - Christian-Alexander Behrendt
- Department of Vascular Medicine, Research Group GermanVasc, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.
| | - Birgit-Christiane Zyriax
- University Professorship for Midwifery Science - Health Care Research and Prevention, IVDP, University Medical Center Hamburg-Eppendorf, Germany.
| | - Eberhard Windler
- Institute for Health Services Research in Dermatology and Nursing, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.
| | - Thea Kreutzburg
- Department of Vascular Medicine, Research Group GermanVasc, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.
| |
Collapse
|
9
|
Mine K, Sugihara M, Fujita T, Kato Y, Gondo K, Arimura T, Takamiya Y, Shiga Y, Kuwano T, Miura SI. Impact of Controlling a Nutritional Status Score on Wound Healing in Patients with Chronic Limb-Threatening Ischemia after Endovascular Treatment. Nutrients 2021; 13:nu13113710. [PMID: 34835966 PMCID: PMC8625291 DOI: 10.3390/nu13113710] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2021] [Revised: 10/14/2021] [Accepted: 10/19/2021] [Indexed: 11/16/2022] Open
Abstract
Background: Chronic limb-threatening ischemia (CLTI) is the most advanced stage of peripheral artery disease. Therefore, a multidisciplinary approach is necessary to avoid major amputation in CLTI patients. Malnutrition worsens the condition of CLTI patients, and therefore, it may be important to evaluate the nutritional status in patients with CLTI. This study was designed to evaluate the baseline patient characteristics and the influence of the controlling nutritional status (CONUT) score on the clinical results. Method and Results: A retrospective, single-center, non-randomized study was conducted to evaluate the associations of death, major amputation, and wound healing rate at 12 months with the CONUT score on admission. Consecutive CLTI patients (mean age 73.2 ± 10.4 years; 84 males) who underwent endovascular therapy (EVT) for infra-popliteal lesions at Fukuoka University Hospital from January 2014 to May 2019 were enrolled and divided into two groups (higher and lower CONUT score groups). The higher CONUT group showed a higher percentage of dialysis (66.7% vs. 33.9%, p < 0.001) and a higher clinical frailty scale (5.9 ± 1.4 vs. 4.9 ± 1.9, p = 0.005) than the lower CONUT group. Rates of amputation-free survival were 89.5% and 69.8% in the lower and higher CONUT groups, respectively. In addition, rates of wound healing at 12 months were 98.0% and 78.3% in the lower and higher CONUT groups, respectively. Multivariate regression analysis demonstrated that a higher CONUT score was an independent predictor for delayed wound healing (OR: 11.2; 95% CI: 1.29–97.5; p = 0.028). Conclusion: An assessment of the nutritional status using the CONUT score could be useful for predicting wound healing, and earlier nutritional intervention may improve the outcome of CLTI patients. Early examination and treatment, along with raising awareness of the issue, may be important for improving the prognosis.
Collapse
Affiliation(s)
- Kaori Mine
- Department of Cardiology, Fukuoka University School of Medicine, 7-45-1 Nanakuma, Jonan-Ku, Fukuoka 814-0180, Japan; (K.M.); (T.F.); (Y.K.); (K.G.); (T.A.); (Y.T.); (Y.S.); (T.K.)
| | - Makoto Sugihara
- Department of Cardiology, Fukuoka University School of Medicine, 7-45-1 Nanakuma, Jonan-Ku, Fukuoka 814-0180, Japan; (K.M.); (T.F.); (Y.K.); (K.G.); (T.A.); (Y.T.); (Y.S.); (T.K.)
- Correspondence: (M.S.); (S.-i.M.); Tel.: +92-801-1011 (M.S. & S.-i.M.); Fax: +092-865-2692 (M.S. & S.-i.M.)
| | - Takafumi Fujita
- Department of Cardiology, Fukuoka University School of Medicine, 7-45-1 Nanakuma, Jonan-Ku, Fukuoka 814-0180, Japan; (K.M.); (T.F.); (Y.K.); (K.G.); (T.A.); (Y.T.); (Y.S.); (T.K.)
| | - Yuta Kato
- Department of Cardiology, Fukuoka University School of Medicine, 7-45-1 Nanakuma, Jonan-Ku, Fukuoka 814-0180, Japan; (K.M.); (T.F.); (Y.K.); (K.G.); (T.A.); (Y.T.); (Y.S.); (T.K.)
| | - Koki Gondo
- Department of Cardiology, Fukuoka University School of Medicine, 7-45-1 Nanakuma, Jonan-Ku, Fukuoka 814-0180, Japan; (K.M.); (T.F.); (Y.K.); (K.G.); (T.A.); (Y.T.); (Y.S.); (T.K.)
| | - Tadaaki Arimura
- Department of Cardiology, Fukuoka University School of Medicine, 7-45-1 Nanakuma, Jonan-Ku, Fukuoka 814-0180, Japan; (K.M.); (T.F.); (Y.K.); (K.G.); (T.A.); (Y.T.); (Y.S.); (T.K.)
| | - Yosuke Takamiya
- Department of Cardiology, Fukuoka University School of Medicine, 7-45-1 Nanakuma, Jonan-Ku, Fukuoka 814-0180, Japan; (K.M.); (T.F.); (Y.K.); (K.G.); (T.A.); (Y.T.); (Y.S.); (T.K.)
| | - Yuhei Shiga
- Department of Cardiology, Fukuoka University School of Medicine, 7-45-1 Nanakuma, Jonan-Ku, Fukuoka 814-0180, Japan; (K.M.); (T.F.); (Y.K.); (K.G.); (T.A.); (Y.T.); (Y.S.); (T.K.)
| | - Takashi Kuwano
- Department of Cardiology, Fukuoka University School of Medicine, 7-45-1 Nanakuma, Jonan-Ku, Fukuoka 814-0180, Japan; (K.M.); (T.F.); (Y.K.); (K.G.); (T.A.); (Y.T.); (Y.S.); (T.K.)
| | - Shin-ichiro Miura
- Department of Cardiology, Fukuoka University School of Medicine, 7-45-1 Nanakuma, Jonan-Ku, Fukuoka 814-0180, Japan; (K.M.); (T.F.); (Y.K.); (K.G.); (T.A.); (Y.T.); (Y.S.); (T.K.)
- Division of Cardiology, Fukuoka University Nishijin Hospital, Fukuoka 814-8522, Japan
- Correspondence: (M.S.); (S.-i.M.); Tel.: +92-801-1011 (M.S. & S.-i.M.); Fax: +092-865-2692 (M.S. & S.-i.M.)
| |
Collapse
|