ORIGINAL ARTICLE  PERIPHERAL ARTERIAL DISEASE Free access

International Angiology 2021 December;40(6):504-11

DOI: 10.23736/S0392-9590.21.04739-8

Copyright © 2021 EDIZIONI MINERVA MEDICA

lingua: Inglese

Impact of nutritional and inflammatory status in patients with critical limb-threatening ischemia

Elena GARCÍA-RIVERA ¹, Enrique M. SAN NORBERTO ¹ ✉, Liliana FIDALGO-DOMINGOS ², Álvaro REVILLA-CALAVIA ¹, Isabel ESTÉVEZ-FERNÁNDEZ ¹, Noelia CENIZO-REVUELTA ¹, Miguel MARTÍN-PEDROSA ¹, Carlos VAQUERO-PUERTA ¹

¹ Department of Angiology and Vascular Surgery, Valladolid University Hospital, Valladolid, Spain; ² Department of Angiology and Vascular Surgery, Centor Hospitalar Universitario do Algarve, Faro, Portugal

BACKGROUND: A pro-inflammatory state and a poor nutritional status have been associated with severity and prognosis of patients with peripheral arterial disease (PAD). The clinical applicability of the different pre-operative nutritional and inflammatory biomarkers in patients with critical limb-threatening ischemia (CLTI) was analyzed.
METHODS: A retrospective observational study was performed, that included all patients with CLTI revascularized from January 2016 to July 2019. The inflammatory state was calculated using neutrophil/lymphocyte (NLR), lymphocyte/monocyte (LMR) and platelet/lymphocyte ratios (PLR). For nutritional status, the Prognostic Nutritional Index (PNI) was calculated. Mortality and number of major amputations at 6 months and hospital length-of stay were studied.
RESULTS: 310 patients were included. Higher levels of NLR and lower levels of PNI were associated with mortality (6.61±5.6 vs. 3.98±3.27, P=0.034; 40.33±7.89 vs. 45.73±7.48, P=0.05, respectively). Lower levels of PNI and LMR (42.57±7.82 vs. 45.44±7.65, P=0.036; 2.77±1.61 vs. 3.22±1.75, P=0.013, respectively) and higher levels of NLR (6.91±7.85 vs. 3.94±2.57, P=0.023) were associated with major amputations. The mean hospital length-of-stay was higher in patients with lower levels of PNI and LMR (P=0.000 and P=0.003) and higher levels of NLR and PLR (P=0.001 and P=0.002). A PNI<42.87 predicted short-term mortality with a 66.7% of sensitivity and a 66.8% of specificity (P=0.000).
CONCLUSIONS: Our experience suggests that these inflammatory and nutritional biomarkers are independent predictors of short-term mortality and major amputations. In addition, our results suggest that PNI could be used to predict the short-term mortality with high sensitivity and specificity.

KEY WORDS: Peripheral arterial disease; Ischemia; Biomarkers; Nutrition assessment; Serum albumin; Mortality