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Natour AK, Shepard AD, Nypaver TJ, Rteil A, Corcoran P, Tang X, Kabbani L. Impact of Preoperative Anemia on Hospitalization, Death, and Overall Survival in Patients With Peripheral Artery Disease Undergoing Endovascular Therapy: A Retrospective Cohort Study in the United States and Canada. J Endovasc Ther 2023:15266028221149926. [PMID: 36680405 DOI: 10.1177/15266028221149926] [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: 01/22/2023]
Abstract
PURPOSE Preoperative anemia is associated with adverse outcomes after cardiac and noncardiac surgeries, but outcomes after an endovascular peripheral vascular intervention (PVI) are not well established. We aimed to assess the association of preoperative anemia with 30 day death, hospital length of stay (LOS), and overall (long term) survival in patients undergoing an endovascular PVI for peripheral artery disease. MATERIALS AND METHODS In this retrospective, cohort study in the United States and Canada, we queried the national Vascular Quality Initiative database for all endovascular PVIs performed between 2010 and 2019, and outcomes were correlated with patients' hemoglobin (Hb) levels. Anemia was classified as mild (Hb=10-13 g/dL for men and 10-12 g/dL for women), moderate (Hb=8-9.9 g/dL), and severe (Hb<8 g/dL). RESULTS A total of 79 707 adult patients who met study criteria underwent endovascular PVI. The mean age was 68 years, and 59% of patients were male. Anemia was documented in 38 543 patients (48%) and was mild in 27 435 (71%), moderate in 9783 (25%), and severe in 1325 (4%). The median follow-up duration was 4 years (range, 1.25-5.78 years). On univariate analysis, 30 day mortality, total LOS, and overall survival were significantly associated with the level of preoperative anemia. These associations persisted in the multivariate models. Kaplan-Meier survival analysis demonstrated an association of death with degree of anemia (p<0.001). CONCLUSION The presence and degree of preoperative anemia were independently associated with increased 30 day mortality and LOS and decreased overall survival for patients with peripheral artery disease who had undergone endovascular PVI. CLINICAL IMPACT The findings from this study have many implications for how to approach vascular surgery in patients with variable hemoglobin levels. Our findings will strengthen our ability to conduct accurate preoperative risk stratification for patients undergoing peripheral vascular interventions. This may also mitigate healthcare expenditures if findings are applied in a way that can lower patient length of postoperative stay while also maintaining quality of care and patient safety. Our results will also serve as guidance for clinical trials, and future prospective trials should evaluate the effect of preoperative optimization of hemoglobin as a potentially modifiable risk factor for outcomes.
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Affiliation(s)
| | | | | | - Ali Rteil
- Division of Vascular Surgery, Henry Ford Hospital, Detroit, MI, USA
| | - Paul Corcoran
- Division of Vascular Surgery, Henry Ford Hospital, Detroit, MI, USA
| | - Xiaoqin Tang
- Division of Vascular Surgery, Henry Ford Hospital, Detroit, MI, USA
| | - Loay Kabbani
- Division of Vascular Surgery, Henry Ford Hospital, Detroit, MI, USA
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2
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Ferreira J, Carneiro A, Vila I, Silva C, Cunha C, Longatto-Filho A, Mesquita A, Cotter J, Mansilha A, Correia-Neves M, Cunha P. Inflammation and Loss of Skeletal Muscle Mass in Chronic Limb Threatening Ischemia. Ann Vasc Surg 2023; 88:164-173. [PMID: 35926785 DOI: 10.1016/j.avsg.2022.07.009] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2022] [Revised: 07/03/2022] [Accepted: 07/06/2022] [Indexed: 12/24/2022]
Abstract
BACKGROUND Lower extremity peripheral arterial disease (PAD) is an atherosclerotic disease of the lower extremities. Atherosclerosis, inflammation, and sarcopenia are independently associated and potentiate each other. Inflammation is deeply involved in the formation and progression of atherosclerosis and is also involved in the pathophysiology of sarcopenia. Sarcopenia is defined as low muscle mass, with low muscle strength. This study aims to determine the differences in skeletal muscle characteristics and in inflammatory parameters between patients with claudication and with chronic limb threatening ischemia (CLTI). METHODS An observational, prospective study in patients with PAD was conducted from January 2018 to December 2020. The clinical characteristics and the cardiovascular risk factors were prospectively registered. The inflammatory parameters determined were: positive acute phase proteins (C-reactive Protein- CRP- and fibrinogen) and negative acute phase proteins albumin, total cholesterol and high-density lipoprotein (HDL). The skeletal muscle area and density were quantified with a computed topography (CT) scan. The strength was determined with a Jamar® hydraulic hand dynamometer. RESULTS A total of 116 patients (mean age: 67.65 ± 9.53 years-old) 64% with claudication and 46% with CLTI were enrolled in the study. No differences were registered between patients with claudication and CLTI on age, cardiovascular risk factors (hypertension, dyslipidemia, diabetes mellitus, and smoking habits) and medication. There was a higher prevalence of men in the claudication group (88.89% vs. 71.70%, P = 0.019). Analyzing the inflammatory parameters, we noted that patients with CLTI had increased serum levels of positive acute phase proteins: CRP (37.53 ± 46.61 mg/L vs. 9.18 ± 26.12 mg/L, P = 0.000), and fibrinogen (466.18 ± 208.07 mg/dL vs. 317.37 ± 79.42 mg/dL, P = 0.000). CLTI patients had decreased negative acute phase proteins: albumin (3.53 ± 0.85 g/dL vs. 3.91 ± 0.72 g/dL, P = 0.001), total cholesterol (145.41 ± 38.59 mg/dL vs. 161.84 ± 34.94 mg/dL, P = 0.013) and HDL (38.70 ± 12.19 mg/dL vs. 51.31 ± 15.85 mg/dL, P = 0.000). We noted that patients with CLTI had lower skeletal muscle area and mass (14,349.77 ± 3,036.60 mm2 vs. 15,690.56 ± 3,183.97 mm2P = 0.013; 10.11 ± 17.03HU vs. 18.02 ± 13.63HU P = 0.013). After adjusting for the variable sex, the association between skeletal muscle density and CLTI persisted (r (97) = -0.232, P = 0.021). The groups did not differ in strength (patients with claudication: 25.39 ± 8.23 Kgf vs. CLTI: 25.17 ± 11.95 Kgf P = 0.910). CONCLUSIONS CLTI patients have decreased skeletal muscle mass and a systemic inflammation status. Recognizing the deleterious triad of atherosclerosis, inflammation and loss of skeletal mass patients with CLTI is an opportunity to improve medical therapy and to perform a timely intervention to stop this vicious cycle.
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Affiliation(s)
- Joana Ferreira
- Vascular Surgery Department - Centro Hospitalar de Trás-os-Montes e Alto Douro, Vila Real, Portugal; Life and Health Science Research Institute (ICVS), School of Medicine, University of Minho, Braga, Portugal; Centro Académico Hospital da Senhora da Oliveira, Guimarães, Portugal; ICVS/3B's - PT Government Associated Laboratory, Guimarães, Portugal.
| | | | - Isabel Vila
- Centro Académico Hospital da Senhora da Oliveira, Guimarães, Portugal; Medicine Department - Hospital da Senhora da Oliveira, Guimarães, Portugal; Center for the Research and Treatment of Arterial Hypertension and Cardiovascular Risk, Internal Medicine Department - Hospital da Senhora da Oliveira, Guimarães, Portugal
| | - Cristina Silva
- Centro Académico Hospital da Senhora da Oliveira, Guimarães, Portugal; Medicine Department - Hospital da Senhora da Oliveira, Guimarães, Portugal; Center for the Research and Treatment of Arterial Hypertension and Cardiovascular Risk, Internal Medicine Department - Hospital da Senhora da Oliveira, Guimarães, Portugal
| | - Cristina Cunha
- Centro Académico Hospital da Senhora da Oliveira, Guimarães, Portugal; Medicine Department - Hospital da Senhora da Oliveira, Guimarães, Portugal; Center for the Research and Treatment of Arterial Hypertension and Cardiovascular Risk, Internal Medicine Department - Hospital da Senhora da Oliveira, Guimarães, Portugal
| | - Adhemar Longatto-Filho
- Life and Health Science Research Institute (ICVS), School of Medicine, University of Minho, Braga, Portugal; ICVS/3B's - PT Government Associated Laboratory, Guimarães, Portugal; Department of Pathology (LIM-14), University of São Paulo School of Medicine, São Paulo, Brazil; Molecular Oncology Research Center, Barretos Cancer Hospital, São Paulo, Brazil
| | - Amílcar Mesquita
- Vascular Surgery Department - Hospital da Senhora da Oliveira, Guimarães, Portugal
| | - Jorge Cotter
- Life and Health Science Research Institute (ICVS), School of Medicine, University of Minho, Braga, Portugal; Centro Académico Hospital da Senhora da Oliveira, Guimarães, Portugal; ICVS/3B's - PT Government Associated Laboratory, Guimarães, Portugal; Medicine Department - Hospital da Senhora da Oliveira, Guimarães, Portugal; Center for the Research and Treatment of Arterial Hypertension and Cardiovascular Risk, Internal Medicine Department - Hospital da Senhora da Oliveira, Guimarães, Portugal
| | - Armando Mansilha
- Center for the Research and Treatment of Arterial Hypertension and Cardiovascular Risk, Internal Medicine Department - Hospital da Senhora da Oliveira, Guimarães, Portugal; Department of Pathology (LIM-14), University of São Paulo School of Medicine, São Paulo, Brazil
| | - Margarida Correia-Neves
- Life and Health Science Research Institute (ICVS), School of Medicine, University of Minho, Braga, Portugal; ICVS/3B's - PT Government Associated Laboratory, Guimarães, Portugal
| | - Pedro Cunha
- Life and Health Science Research Institute (ICVS), School of Medicine, University of Minho, Braga, Portugal; Centro Académico Hospital da Senhora da Oliveira, Guimarães, Portugal; ICVS/3B's - PT Government Associated Laboratory, Guimarães, Portugal; Medicine Department - Hospital da Senhora da Oliveira, Guimarães, Portugal; Center for the Research and Treatment of Arterial Hypertension and Cardiovascular Risk, Internal Medicine Department - Hospital da Senhora da Oliveira, Guimarães, Portugal
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Compagnon A, Lazareth I, Fels A, Chatellier G, Emmerich J, Michon-Pasturel U, Priollet P, Yannoutsos A. Peri-procedural complications following endovascular revascularization for critical limb ischemia. JOURNAL DE MEDECINE VASCULAIRE 2022; 47:175-185. [PMID: 36344028 DOI: 10.1016/j.jdmv.2022.10.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/02/2022] [Accepted: 10/10/2022] [Indexed: 06/16/2023]
Abstract
OBJECTIVE Revascularization procedures are considered the cornerstone of therapy in patients with critical limb ischemia (CLI) and multiple procedures are often required to attain limb salvage. The aim of the present study is to determine the prevalence of peri-procedural complications after endovascular procedure, and to determine the clinical and biological characteristics of patients associated to the risk of peri-procedural complications. METHODS From November 2013 to May 2021, 324 consecutive patients were retrospectively included, of whom 99 underwent more than one revascularization procedure for contralateral CLI or clinical recurrence of CLI. A total of 532 revascularizations were performed. Clinical and biological parameters were recorded at baseline before endovascular revascularization. The occurrence of a peri-procedural complication (local complications, fatal and non-fatal major bleeding or cardiovascular events) was recorded up to 30days after revascularization. Univariate and multivariate analyses were performed to study the parameters associated with per-procedural complications. A P<0.05 was considered as statistically significant. RESULTS A total of 324 consecutive patients were included, 177 men and 147 women with CLI, with a mean age of 77.6±11.9years. Most of these patients had cardiovascular comorbidities (41% with a history of coronary heart disease, 78% treated hypertensive patients, 49% diabetic patients). Peri-procedural mortality occurred in 13 patients (4%) and 9 patients (2.8%) experienced major amputation at one-month following revascularization. Among the 532 revascularization procedures, 99 major bleeding events (22.8% of the cohort population) and 31 cardiovascular events (8.6% of the cohort population), were recorded in the peri-procedural period. Cardiovascular events were associated with peri-procedural mortality. Complications at the puncture site occurred during 38 of the 532 procedures (10.2% of the cohort population). Compared with patients undergoing a single revascularization procedure, patients with multiple procedures presented a higher risk of major bleeding events (48.5% vs. 11.6%, P<0.0001) and access site complications (20.2% vs. 5.78%, P<0.0001). In multivariate analysis, pulse pressure <60mmHg and hemoglobin level <10g/dl were correlated with the occurrence of major bleeding events; left ventricular ejection fraction<60% and the absence of statin treatment were correlated with the occurrence of cardiovascular complications; a high chronological rank of revascularization was correlated with the occurrence of local complication. Finally, age and gender were not associated with the occurrence of peri-procedural complication. CONCLUSION The present results highlight that multiple revascularization procedures for limb salvage are required in almost one third of the population with critical limb ischemia and were associated with the risk of major bleeding events and access site complications. The most frequent complications of peripheral vascular interventions were major bleeding events. Adverse cardiovascular events were related with peri-procedural mortality. Anemia, blood pressure, left ventricular ejection fraction and statin treatment are important parameters to consider for peri-procedural outcomes, independently of age, gender and the chronological rank of revascularization procedure.
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Affiliation(s)
- A Compagnon
- Vascular medicine department, Groupe Hospitalier Paris Saint-Joseph, Resident Sorbonne Université, Paris, France; Department of Clinical Research, GH Paris Saint-Joseph, 185, rue Raymond Losserand, 75014 Paris, France
| | - I Lazareth
- Vascular medicine department, Groupe Hospitalier Paris Saint-Joseph, Resident Sorbonne Université, Paris, France
| | - A Fels
- Department of Clinical Research, GH Paris Saint-Joseph, 185, rue Raymond Losserand, 75014 Paris, France
| | - G Chatellier
- Department of Clinical Research, GH Paris Saint-Joseph, 185, rue Raymond Losserand, 75014 Paris, France
| | - J Emmerich
- Vascular medicine department, Groupe Hospitalier Paris Saint-Joseph, Resident Sorbonne Université, Paris, France; Inserm UMR 1153-CRESS, Université Paris Cité, Paris, France
| | - U Michon-Pasturel
- Vascular medicine department, Groupe Hospitalier Paris Saint-Joseph, Resident Sorbonne Université, Paris, France
| | - P Priollet
- Vascular medicine department, Groupe Hospitalier Paris Saint-Joseph, Resident Sorbonne Université, Paris, France
| | - A Yannoutsos
- Vascular medicine department, Groupe Hospitalier Paris Saint-Joseph, Resident Sorbonne Université, Paris, France; Inserm UMR 1153-CRESS, Université Paris Cité, Paris, France.
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4
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Koh BJ, Lee Q, Wee IJ, Syn N, Lee KS, Jie Ng J, Wong ALA, Soong JT, Mtl Choong A. Frailty scoring in vascular and endovascular surgery: A systematic review. Vasc Med 2022; 27:302-307. [PMID: 35681271 DOI: 10.1177/1358863x221093400] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
One in 10 independently living adults aged 65 years old and older is considered frail, and frailty is associated with poor postoperative outcomes. This systematic review aimed to examine the association between frailty assessments and postoperative outcomes in patients with vascular disease. Electronic databases - MEDLINE, Embase, and the Cochrane Library - were searched from inception until January 2022, resulting in 648 articles reviewed for potential inclusion and 16 studies selected. Demographic data, surgery type, frailty measure, and postoperative outcomes predicted by frailty were extracted from the selected studies. The risk of bias was assessed using the Newcastle-Ottawa Scale. The selected studies (mean age: 56.1-76.3 years) had low-to-moderate risk of bias and included 16 vascular (elective and nonelective) surgeries and eight frailty measures. Significant associations (p < 0.05) were established between mortality (30-day, 90-day, 1-year, 5-year), 30-day morbidity, nonhome discharge, adverse events, failure to rescue, patient requiring care after discharge, and amputation following critical limb ischaemia. The strongest evidence was found between 30-day mortality and frailty. Composite 30-day morbidity and mortality, functional status at discharge, length of stay, spinal cord deficit, and access site complications were found to be nonsignificantly associated with frailty. With frailty being significantly associated with several adverse postoperative outcomes, preoperative frailty assessments can potentially be clinically useful in helping practitioners predict and guide the pre-, peri-, and postoperative management of frail with vascular disease.
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Affiliation(s)
- Bernard Jqw Koh
- SingVaSC, Singapore Vascular Collaborative, Singapore.,Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Quinncy Lee
- SingVaSC, Singapore Vascular Collaborative, Singapore.,Faculty of Health Sciences, University of Hull, Kingston upon Hull, UK.,The Institute of Applied Health Sciences, The School of Medicine, Medical Sciences, and Nutrition, University of Aberdeen, Aberdeen, UK
| | - Ian Jy Wee
- SingVaSC, Singapore Vascular Collaborative, Singapore.,Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Nicholas Syn
- SingVaSC, Singapore Vascular Collaborative, Singapore.,Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Keng Siang Lee
- SingVaSC, Singapore Vascular Collaborative, Singapore.,Bristol Medical School, Faculty of Health Sciences, University of Bristol, Bristol, UK
| | - Jun Jie Ng
- SingVaSC, Singapore Vascular Collaborative, Singapore.,Cardiovascular Research Institute, National University Heart Centre Singapore, Singapore.,Department of Surgery, Yong Loo Lin School of Medicine, National University of Singapore, Singapore.,Division of Vascular and Endovascular Surgery, National University Heart Centre Singapore, Singapore
| | - Audrey LA Wong
- SingVaSC, Singapore Vascular Collaborative, Singapore.,Division of Advanced Internal Medicine, National University Hospital, Singapore.,Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - John Ty Soong
- SingVaSC, Singapore Vascular Collaborative, Singapore.,Division of Advanced Internal Medicine, National University Hospital, Singapore.,Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Andrew Mtl Choong
- SingVaSC, Singapore Vascular Collaborative, Singapore.,Cardiovascular Research Institute, National University Heart Centre Singapore, Singapore.,Department of Surgery, Yong Loo Lin School of Medicine, National University of Singapore, Singapore.,Division of Vascular and Endovascular Surgery, National University Heart Centre Singapore, Singapore
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5
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Esteban C, Hernández-Rodríguez I. Peripheral arterial disease and anaemia. A review. Med Clin (Barc) 2021; 158:221-228. [PMID: 34602211 DOI: 10.1016/j.medcli.2021.07.010] [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: 03/24/2021] [Revised: 07/05/2021] [Accepted: 07/06/2021] [Indexed: 12/24/2022]
Abstract
Iron deficiency anaemia is highly prevalent worldwide. In the surgical patient, anaemia of any cause implies higher morbidity and mortality in the post-operative period. This is especially important in patients with peripheral artery disease, as they have very high rates of anaemia due to iron deficiency or other causes. In intermittent claudication, anaemia is a predictor of death in the medium term. Patients with critical ischaemia have higher prevalence of anaemia and it is an indicator of amputation and death in the medium term. Specific protocols need to be developed for these patients since the natural history of their disease does not allow for the correction of anaemia before surgery.
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Affiliation(s)
- Carlos Esteban
- Servicio de Angiología y Cirugía Vascular, Hospital Universitari Germans Trias i Pujol, Badalona, Barcelona, Spain
| | - Inés Hernández-Rodríguez
- Servicio de Hematología, ICO-Hospital Universitari Germans Trias i Pujol, Institute de Investigación contra la Leucemia Josep Carreras, Universitat Autònoma de Barcelona, Badalona, Barcelona, España.
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Lüders F, Engelbertz C, Meyborg M, Freisinger E, Malyar NM, Zeller T, Reinecke H. Acute and chronic anemia and short- and long-term outcome of patients with peripheral arterial disease and critical limb ischemia. Eur J Intern Med 2016; 31:62-7. [PMID: 27021473 DOI: 10.1016/j.ejim.2016.03.002] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/22/2015] [Revised: 02/18/2016] [Accepted: 03/02/2016] [Indexed: 11/20/2022]
Abstract
BACKGROUND Evident data about the additive effect of "the fifth cardiovascular risk factor" (anemia) and peripheral arterial disease (PAD) focused on morbidity and outcome of patients with PAD are currently still missing. METHODS AND RESULTS A total of 41,882 PAD patients were included. Of these, 5566 (13.3%) suffered from anemia. Patients with anemia were older (P<0.001), suffered more often from chronic kidney disease (P<0.001), coronary artery disease (P<0.001), and more severe PAD (P<0.001). However, they received significantly less endovascular revascularizations (P<0.001), had higher amputation rates (acute anemia: 3.7-fold, P<0.001; nutritional, aplastic, and anemia in chronic disease: 2.9-fold, P<0.001), higher in-hospital mortality rates (acute anemia: 6.4-fold, P<0.001; nutritional, aplastic, and anemia in chronic disease: 4.6-fold; P<0.001), had significantly higher in-hospital complications (P<0.001) compared to those without anemia. During a follow-up time up to 4years (until Dec. 31st, 2012, median 775days, 25th-75th percentiles 469-1120days) nutritional, aplastic, and anemia in chronic disease and acute anemia were high significant predictors of long-term mortality and amputation (each P<0.001). Lengths of hospital stay and reimbursement costs were higher (nutritional, aplastic, and anemia in chronic disease: 2-fold higher (P<0.001), acute anemia: 3-fold higher (P<0.001)) than in patients without anemia. CONCLUSION This study illustrates from a large, comprehensive database the association of acute, nutritional, aplastic, and anemia in chronic disease on morbidity, in-hospital treatment and complications, short- and long term outcome, and costs of patients with PAD.
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Affiliation(s)
- Florian Lüders
- Division of Vascular Medicine, Department of Cardiovascular Medicine, University Hospital Muenster, Muenster, Germany.
| | - Christiane Engelbertz
- Division of Vascular Medicine, Department of Cardiovascular Medicine, University Hospital Muenster, Muenster, Germany.
| | - Matthias Meyborg
- Division of Vascular Medicine, Department of Cardiovascular Medicine, University Hospital Muenster, Muenster, Germany.
| | - Eva Freisinger
- Division of Vascular Medicine, Department of Cardiovascular Medicine, University Hospital Muenster, Muenster, Germany.
| | - Nasser M Malyar
- Division of Vascular Medicine, Department of Cardiovascular Medicine, University Hospital Muenster, Muenster, Germany.
| | - Thomas Zeller
- Department of Cardiovascular Medicine, University Hospital of Freiburg, Bad Krozingen, Germany.
| | - Holger Reinecke
- Division of Vascular Medicine, Department of Cardiovascular Medicine, University Hospital Muenster, Muenster, Germany.
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Luo H, Yuan D, Yang H, Yukui M, Huang B, Yang Y, Xiong F, Zeng G, Wu Z, Chen X, Wang T, Luo H, Zhao J. Post-treatment neutrophil-lymphocyte ratio independently predicts amputation in critical limb ischemia without operation. Clinics (Sao Paulo) 2015; 70:273-7. [PMID: 26017794 PMCID: PMC4418355 DOI: 10.6061/clinics/2015(04)09] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/26/2014] [Accepted: 01/27/2015] [Indexed: 02/05/2023] Open
Abstract
OBJECTIVES Limited information is available concerning the post-treatment neutrophil-lymphocyte ratio in critical limb ischemia patients who receive conservative therapy. Accordingly, this study was designed to evaluate the predictive value of the post-treatment neutrophil-lymphocyte ratio in critical limb ischemia patients without surgery. METHOD From January 2009 to January 2011, critical limb ischemia patients were admitted to a vascular center. The demographic data, patient histories, comorbidities and risk factors were documented, and the differential cell count was determined at admission and seven days later after conservative therapy. The cutoff value of the post-treatment neutrophil-lymphocyte ratio was determined by an ROC curve. Patients were divided into groups A and B according to the cutoff value. Amputation-free survival was compared between groups. Univariate and multivariate analyses were used to identify independent risk factors. RESULT A total of 172 patients were identified with a mean age 71.98±10.09 years; among them, 122 were male. A value of 3.8 was identified as the cutoff value of the post-treatment neutrophil-lymphocyte ratio. Groups A (post-treatment neutrophil-lymphocyte ratio ≥3.8) and B (post-treatment neutrophil-lymphocyte ratio <3.8) showed a significant difference in amputation-free survival (P<0.001). The 1-year, 2-year and 3-year amputation-free survival rates were 79.6%, 55.6% and 46.3%, respectively, in group A; however, in group B, these values were 89.7%, 79.3% and 75.9%, respectively. The post-treatment neutrophil-lymphocyte ratio was identified as an independent predictive factor for amputation in critical limb ischemia patients (P<0.001). CONCLUSION The post-treatment neutrophil-lymphocyte ratio is an independent predictive factor for amputation in critical limb ischemia patients. Patients with a post-treatment neutrophil-lymphocyte ratio ≥3.8 are likely to suffer from amputation; amputation-free survival usually occurs in patients with a post-treatment neutrophil-lymphocyte ratio <3.8.
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Affiliation(s)
- Han Luo
- Sichuan University, West China Hospital, Chengdu, Sichuan Province, China
| | - Ding Yuan
- Sichuan University, West China Hospital, Department of Vascular Surgery, Chengdu, Sichuan Province, China
| | - Hongliu Yang
- Sichuan University, West China Hospital, Chengdu, Sichuan Province, China
| | - Ma Yukui
- Sichuan University, West China Hospital, Department of Vascular Surgery, Chengdu, Sichuan Province, China
| | - Bin Huang
- Sichuan University, West China Hospital, Department of Vascular Surgery, Chengdu, Sichuan Province, China
| | - Yi Yang
- Sichuan University, West China Hospital, Department of Vascular Surgery, Chengdu, Sichuan Province, China
| | - Fei Xiong
- Sichuan University, West China Hospital, Department of Vascular Surgery, Chengdu, Sichuan Province, China
| | - Guojun Zeng
- Sichuan University, West China Hospital, Department of Vascular Surgery, Chengdu, Sichuan Province, China
| | - Zhoupeng Wu
- Sichuan University, West China Hospital, Department of Vascular Surgery, Chengdu, Sichuan Province, China
| | - Xiyang Chen
- Sichuan University, West China Hospital, Department of Vascular Surgery, Chengdu, Sichuan Province, China
| | - Tiehao Wang
- Sichuan University, West China Hospital, Department of Vascular Surgery, Chengdu, Sichuan Province, China
| | - Hailong Luo
- Sichuan University, West China Hospital, Chengdu, Sichuan Province, China
| | - Jichun Zhao
- Sichuan University, West China Hospital, Department of Vascular Surgery, Chengdu, Sichuan Province, China
- E-mail:
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8
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Oshin OA, Torella F. Low Hemoglobin Concentration Is Associated With Poor Outcome After Peripheral Arterial Surgery. Vasc Endovascular Surg 2013; 47:449-53. [DOI: 10.1177/1538574413493679] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Objective: To assess the influence of low hemoglobin (Hb) concentration on major adverse cardiac events (MACE) and mortality in patients undergoing peripheral arterial surgery. Methods: This was a retrospective cohort study of patients undergoing peripheral arterial reconstructive surgery at a tertiary vascular center. Preoperative factors linked with the occurrence of MACE and death on univariate analysis ( P ≤ .1) were included in a multivariate model to confirm the independent association with the outcome variables. Results: A total of 360 consecutive patients (238 men) with a mean (standard deviation) age of 69 (10.7) years and Hb of 13.0 (2.12) g/dL treated under the care of a single specialist between January 2004 and December 2011 were included in the analysis. Of these, 193 (53.6%) were anemic. In all, 26 (7%) had a postoperative MACE and 18 (5%) died. On multivariate analysis, age > 80 years (odds ratio [OR] = 3; 95% confidence interval [CI] [1.2-7.5]; P = .025), renal impairment (OR = 3.2; 95% CI [.99-10.2]; P = .053), coronary disease (OR = 3.6; 95% CI [1.5-8.7]; P = .005), and low Hb (OR for each 1 g/dL drop below the mean = 1.4 [1.13-1.7]; P = .002) were independent risk factors for MACE. Unplanned surgery (OR = 4.5; 95% CI [1.2-16.9]; P = .025) and low Hb (OR for each 1 g/dL drop below the mean = 1.5; 95% CI [1.14-1.86]; P = .002) were independent risk factors for death. Conclusion: In peripheral arterial surgery, preoperative low Hb is associated with MACE and death. Further investigation is necessary to elucidate whether this relationship is causal. Meanwhile, consideration should be given to treating preoperative anemia as a significant risk factor for adverse outcome in this setting.
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Affiliation(s)
- O. A. Oshin
- Liverpool Vascular and Endovascular Service, University Hospital Aintree, Liverpool, United Kingdom
| | - F. Torella
- Liverpool Vascular and Endovascular Service, University Hospital Aintree, Liverpool, United Kingdom
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9
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Bravo Ruiz E, Vega De Céniga M, Izagirre Loroño M, Casco Aguilar C, Estallo Laliena L, Barba Vélez Á. Déficits nutricionales en pacientes con isquemia crónica de extremidades inferiores. ANGIOLOGIA 2012. [DOI: 10.1016/j.angio.2012.02.007] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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Bibliography. Obstetric and gynaecological anesthesia. Current world literature. Curr Opin Anaesthesiol 2011; 24:354-6. [PMID: 21637164 DOI: 10.1097/aco.0b013e328347b491] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Vega de Céniga M, Bravo E, Izagirre M, Casco C, Estallo L, Esteban M, Barba A. Anaemia, iron and vitamin deficits in patients with peripheral arterial disease. Eur J Vasc Endovasc Surg 2011; 41:828-30. [PMID: 21353606 DOI: 10.1016/j.ejvs.2011.01.017] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2010] [Accepted: 01/19/2011] [Indexed: 10/18/2022]
Abstract
INTRODUCTION Anaemia can compromise muscle and organ function. Related iron and vitamin body stores have seldom been assessed in patients with peripheral arterial disease. REPORT We retrospectively analysed basal prevalence of anaemia, iron, B(12)-vitamin and folic acid deficits in 420 patients with claudication and 204 patients with critical limb ischaemia (CLI). The prevalence of the evaluated parameters was 9.8%, 6.7%, 6.7% and 2.9% among patients with claudication but 49.5%, 31.9%, 15.7% and 6.4% among CLI patients, respectively (p < 0.05 for all). DISCUSSION Anaemia, iron and vitamin deficits are uncommon among patients with ischemic claudication but very prevalent among patients with CLI.
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Affiliation(s)
- M Vega de Céniga
- Department of Angiology and Vascular Surgery, Hospital de Galdakao-Usansolo, Barrio Labeaga S/N, 48960 Galdakao (Bizkaia), Spain.
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