Shiraki T, Iida O, Takahara M, Masuda M, Okamoto S, Ishihara T, Nanto K, Kanda T, Fujita M, Uematsu M
Kansai Rosai Hospital Cardiovascular Center, Amagasaki, Hyogo, Japan.
Kansai Rosai Hospital Cardiovascular Center, Amagasaki, Hyogo, Japan.
Eur J Vasc Endovasc Surg. 2016 Aug;52(2):218-24. doi: 10.1016/j.ejvs.2016.05.016. Epub 2016 Jun 26.
Patients with critical limb ischemia (CLI) have poor overall and limb prognosis. Although nutritional status influences overall prognosis, and the Geriatric Nutritional Risk Index (GNRI) is a widely used, simple and well established nutritional status screening method, the association between the GNRI and the overall and limb prognosis of patients with CLI following endovascular therapy (EVT) has not been explored.
Clinical outcomes were retrospectively evaluated in 473 consecutive patients (74 ± 10 years; 59% male) with CLI who underwent EVT. The GNRI on admission was calculated as follows: [14.89 × albumin (g/dL)] + [41.7 × (body weight/ideal body weight)]. Cox proportional hazard analysis was performed to explore the independent association between the GNRI and mortality and major amputation.
Patients (53% ambulatory, 38% wheelchair bound, and 9% bedridden) were divided into two groups based on the median GNRI: the higher group (GNRI ≥ 91.2, n = 237) and the lower group (GNRI < 91.2, n = 236). Median follow up duration after EVT was 11.3 months. Three years after EVT, the survival rate (74% in the higher GNRI, and 48% in the lower GNRI, respectively), and limb salvage rate (92% in the higher GNRI, and 84% in the lower GNRI) were significantly lower in the lower GNRI group. GNRI (hazard ratio [HR], 1.03; 95% confidence interval [CI], 1.01-1.05), along with being wheelchair bound (HR, 1.87; 95% CI 1.17-2.97; vs. ambulatory status), being bedridden (HR, 3.10; 95% CI, 1.63-2.97; vs. ambulatory status), being on hemodialysis (HR, 2.33; 95% CI, 1.49-3.64), and having chronic heart failure (HR, 2.22; 95% CI, 1.44-3.43) were the independent predictors of mortality. The GNRI (HR, 1.04; 95% CI, 1.01-1.07), being bedridden (HR, 4.15; 95% CI, 1.67-10.3; vs. ambulatory status), isolated below knee disease (HR, 2.49; 95% CI, 1.30-4.77), and hemodialysis (HR, 2.44; 95% CI, 1.23-4.85) were independently associated with major amputation.
The GNRI on admission was independently associated with mortality and major amputation after EVT in patients with CLI.
严重肢体缺血（CLI）患者的总体及肢体预后较差。尽管营养状况会影响总体预后，且老年营养风险指数（GNRI）是一种广泛应用、简单且成熟的营养状况筛查方法，但尚未探讨GNRI与接受血管内治疗（EVT）的CLI患者的总体及肢体预后之间的关联。
对473例接受EVT的CLI连续患者（74±10岁；59%为男性）的临床结局进行回顾性评估。入院时的GNRI计算如下：[14.89×白蛋白（g/dL）]+[41.7×（体重/理想体重）]。进行Cox比例风险分析以探讨GNRI与死亡率及大截肢之间的独立关联。
患者（53%可步行，38%需轮椅辅助，9%卧床）根据GNRI中位数分为两组：较高组（GNRI≥91.2，n = 237）和较低组（GNRI < 91.2，n = 236）。EVT后的中位随访时间为11.3个月。EVT三年后，较低GNRI组的生存率（较高GNRI组为74%，较低GNRI组为48%）和肢体挽救率（较高GNRI组为92%，较低GNRI组为84%）显著更低。GNRI（风险比[HR]，1.03；95%置信区间[CI]，1.01 - 1.05），以及需轮椅辅助（HR，1.87；95% CI 1.17 - 2.97；与可步行状态相比）、卧床（HR，3.10；95% CI，1.63 - 2.97；与可步行状态相比）、接受血液透析（HR，2.33；95% CI，1.49 - 3.64）和患有慢性心力衰竭（HR，2.22；95% CI，1.44 - 3.43）是死亡率的独立预测因素。GNRI（HR，1.04；95% CI，1.01 - 1.07）、卧床（HR，4.15；95% CI，1.67 - 10.3；与可步行状态相比）、孤立性膝下疾病（HR，2.49；95% CI，1.30 - 4.77）和血液透析（HR，2.44；95% CI，1.23 - 4.85）与大截肢独立相关。
入院时的GNRI与接受EVT的CLI患者的死亡率及大截肢独立相关。
