Elevated Composite Inflammatory Markers are Associated with Clinical Severity and Long-term Amputation Risk in Patients with Critical Limb Ischemia after Percutaneous Transluminal Angioplasty
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30 set 2024
INFORMAZIONI SU QUESTO ARTICOLO
Categoria dell'articolo: Original Research
Pubblicato online: 30 set 2024
Pagine: 102 - 110
Ricevuto: 09 mag 2024
Accettato: 26 giu 2024
DOI: https://doi.org/10.2478/jce-2024-0014
Parole chiave
© 2024 Adrian Vasile Mureșan et al., published by Sciendo
This work is licensed under the Creative Commons Attribution-NonCommercial-NoDerivatives 3.0 License.
FIGURE 1.
FIGURE 2.
FIGURE 3.
ROC analysis for predicting clinical severity and major amputation
| SII | – | 0.633 | 0.057 | 0.492–0.715 | – | – | 0.052 |
| SIRI | 1.68 | 0.698 | 0.053 | 0.594–0.803 | 77.2% | 52.4% | <0.001 |
| AISI | 362.25 | 0.680 | 0.055 | 0.572–0.787 | 80.7% | 50.0% | 0.001 |
| SII | 961.68 | 0.731 | 0.067 | 0.600–0.862 | 81.3% | 69.9% | 0.001 |
| SIRI | 1.49 | 0.712 | 0.060 | 0.595–0.829 | 93.8% | 42.2% | <0.001 |
| AISI | 395.68 | 0.698 | 0.067 | 0.568–0.829 | 87.5% | 47.0% | 0.003 |
Patient characteristics by clinical severity
| Age, years, mean ± s.d. | 70.59 ± 9.13 | 68.86 ± 7.62 | 71.86 ± 9.96 | 0.081 |
| Male, n (%) | 81 (77.88%) | 33 (75.00%) | 48 (80.00%) | 0.794 |
| Hypertension | 90 (86.53%) | 38 (86.36%) | 52 (86.67%) | 0.133 |
| Ischemic heart disease | 61 (58.65%) | 21 (47.72%) | 40 (66.67%) | 0.305 |
| Chronic heart failure | 42 (40.38%) | 14 (31.81%) | 28 (46.66%) | 0.127 |
| Atrial fibrillation | 12 (11.54%) | 3 (6.81%) | 9 (15.0%) | 0.197 |
| Cardiovascular events | 13 (12.50%) | 4 (9.09%) | 9 (15.0%) | 0.368 |
| Cerebrovascular events | 14 (13.46%) | 4 (9.09%) | 10 (16.67%) | 0.263 |
| Diabetes mellitus | 63 (60.57%) | 23 (52.27%) | 40 (66.67%) | 0.529 |
| Varicose veins | 11 (10.57%) | 4 (9.09%) | 7 (11.67%) | 0.673 |
| Obesity | 26 (25.0%) | 9 (20.45%) | 17 (28.33%) | 0.359 |
| Active smoking | 50 (48.07%) | 21 (47.72%) | 29 (48.33%) | 0.951 |
| Dyslipidemia | 49 (47.11%) | 18 (40.91%) | 31 (51.67%) | 0.278 |
| Hemoglobin, g/dl | 12.62 ± 1.86 | 13.07 ± 1.75 | 12.28 ± 1.89 | 0.030 |
| Hematocrit, % | 38.16 ± 5.22 | 98.29 ± 4.53 | 37.33 ± 5.56 | 0.098 |
| Leukocytes, × 103/µl | 9.44 ± 3.09 | 8.45 ± 2.69 | 10.17 ± 3.19 | 0.005 |
| BUN, mg/dl | 45.05 ± 24.97 | 38.61 ± 12.73 | 49.39 ± 29.91 | 0.163 |
| Creatinine, mg/dl | 1.31 ± 1.52 | 0.98 ± 0.29 | 1.55 ± 1.96 | 0.829 |
| eGFR, ml/min/1.73 m2 | 82.20 ± 31.91 | 83.16 ± 24.87 | 81.48 ± 36.52 | 0.813 |
| Glucose, mg/dl | 132.33 ± 58.99 | 128.83 ± 50.75 | 134.91 ± 64.72 | 0.840 |
| AST, U/L | 19.83 ± 8.41 | 20.56 ± 9.10 | 19.30 ± 7.92 | 0.580 |
| ALT, U/L | 19.74 ± 11.60 | 20.28 ± 10.84 | 19.34 ± 12.21 | 0.439 |
| Neutrophils, × 103/µl | 6.67 ± 2.79 | 5.70 ± 2.16 | 7.38 ± 3.01 | 0.002 |
| Lymphocytes, × 103/µl | 2.04 ± 1.48 | 1.93 ± 0.69 | 2.12 ± 1.86 | 0.840 |
| Monocytes, × 103/µl | 0.73 ± 0.31 | 0.62 ± 0.29 | 0.79 ± 0.29 | <0.001 |
| PLT, × 103/µl | 271.60 ± 105.54 | 258.35 ± 75.25 | 281.37 ± 122.96 | 0.671 |
| INR | 1.18 ± 0.35 | 1.19 ± 0.37 | 1.17 ± 0.33 | 0.461 |
| aPTT | 28.83 ± 11.36 | 28.50 ± 12.84 | 29.12 ± 10.04 | 0.465 |
| Major amputation, n (%) | 16 (15.38%) | 6 (13.63%) | 10 (16.67%) | 0.672 |
| Mortality, n (%) | 13 (12.50%) | 3 (6.81%) | 9 (15.0%) | 0.134 |
| Follow-up period, years, mean ± s.d. | 1.26 ± 0.81 | 1.32 ± 0.84 | 1.22 ± 0.79 | 0.785 |
| Length of stay, days, mean ± s.d. | 6.17 ± 4.13 | 6.02 ± 4.08 | 6.28 ± 4.20 | 0.782 |
Characteristics of atherosclerotic lesions of the infrainguinal arteries at preoperative CTA
| Superficial femoral artery | 70–90% | 10 (9.61%) | 4 (9.09%) | 6 (10.0%) | 0.877 |
| 90–99% | 14 (13.46%) | 7 (15.91%) | 7 (11.66%) | 0.531 | |
| Occlusion | 17 (16.34%) | 10 (22.72%) | 7 (11.66%) | 0.132 | |
| Popliteal artery | 70–90% | 6 (5.76%) | 2 (4.54%) | 4 (6.67%) | 0.647 |
| 90–99% | 12 (11.53%) | 7 (15.91%) | 5 (8.33%) | 0.232 | |
| Occlusion | 13 (12.5%) | 2 (4.54%) | 11 (18.33%) | 0.036 |
|
| Anterior tibial artery | 70–90% | 3 (2.88%) | - | 3 (5.0%) | 0.132 |
| 90–99% | 10 (9.61%) | 1 (2.27%) | 9 (15.0%) | 0.007 |
|
| Occlusion | 28 (26.92%) | 10 (22.72%) | 18 (30.0%) | 0.409 | |
| Posterior tibial artery | 70–90% | 2 (1.92%) | - | 2 (3.33%) | 0.221 |
| 90–99% | 8 (7.69%) | 1 (2.27%) | 7 (11.66%) | 0.076 | |
| Occlusion | 34 (32.69%) | 10 (22.72%) | 24 (40.0%) | 0.064 | |
| Peroneal artery | 70–90% | 3 (2.88%) | 1 (2.27%) | 2 (3.33%) | 0.221 |
| 90–99% | 15 (14.42%) | 4 (9.09%) | 11 (18.33%) | 0.185 | |
| Occlusion | 7 (6.73%) | 1 (2.27%) | 6 (10.0%) | 0.031 |
Factors predicting clinical severity and long-term risk of major amputation following PTA
| Male | 1.33 | 0.52–3.38 | 0.545 | 1.34 | 0.38–4.70 | 0.649 |
| Age | 1.41 | 0.94–2.12 | 0.100 | 0.98 | 0.61–1.59 | 0.928 |
| Ischemic heart disease | 1.52 | 0.68–3.39 | 0.306 | 1.31 | 0.89–1.93 | 0.159 |
| Diabetes mellitus | 1.45 | 0.66–3.17 | 0.351 | 2.59 | 0.86–7.74 | 0.089 |
| Obesity | 1.54 | 0.61–3.87 | 0.361 | 0.82 | 0.26–2.55 | 0.729 |
| Active smoking | 1.03 | 0.47–2.23 | 0.951 | 1.75 | 0.59–4.96 | 0.262 |
| Dyslipidemia | 1.55 | 0.71–3.38 | 0.279 | 1.24 | 0.46–3.34 | 0.672 |
| Leriche-Fontaine III | – | – | – | 0.77 | 0.28–2.12 | 0.612 |
| Leriche-Fontaine IV | – | – | – | 1.30 | 0.47–3.57 | |
| SII | 1.71 |
1.04–3.46 | 0.055 | 1.56 |
1.11–2.19 | 0.010 |
| SIRI | 2.28 |
1.16–4.49 | 0.017 | 1.63 |
1.13–2.36 | 0.009 |
| AISI | 2.32 |
1.03–5.26 | 0.043 | 1.55 |
1.08–2.22 | 0.016 |