Morisaki Koichi, Yamaoka Terutoshi, Iwasa Kazuomi, Ohmine Takahiro
Department of Vascular Surgery, Matsuyama Red Cross Hospital, Ehime, Japan.
Department of Vascular Surgery, Matsuyama Red Cross Hospital, Ehime, Japan.
J Vasc Surg. 2017 Dec;66(6):1758-1764. doi: 10.1016/j.jvs.2017.04.048. Epub 2017 Jun 21.
It is unclear whether frailty adversely affects treatment outcomes in patients with critical limb ischemia (CLI). The aim of this study was to investigate the influence of frailty on CLI patients after revascularization.
Patients undergoing infrapopliteal revascularization between 2007 and 2015 were retrospectively analyzed. The patient was defined as CLI frail when two or more of the following were present: low Geriatric Nutritional Risk Index, low skeletal muscle mass index, or nonambulatory status. The primary study end point was 2-year amputation-free survival (AFS). To analyze the diagnostic criteria of frailty, the CLI Frailty Index was compared with a modified Frailty Index using a receiver operating characteristic area under the curve. The secondary end points were occurrence of Clavien-Dindo class IV complications and 30-day or hospital mortality.
During the study period, 266 patients and 325 limbs underwent infrapopliteal revascularization. The AFS rate 1 year and 2 years after revascularization was 81.8% and 72.9% for the CLI frail- group vs 45.8% and 34.0% for the CLI frail+ group (P < .001), respectively. Multivariate analysis revealed that the CLI Frailty Index (hazard ratio [HR], 2.77; 95% confidence interval [CI], 1.78-4.32; P < .001) and hemodialysis (HR, 1.72; 95% CI, 1.11-2.69; P = .02) were risk factors for AFS 2 years after revascularization. The CLI Frailty Index area under the curve was 0.72 compared with 0.63 for the modified Frailty Index (P = .01). Only the CLI Frailty Index was found to be a risk factor for morbidity (HR, 3.21; 95% CI, 1.45-7.27; P = .004) and 30-day or hospital mortality (HR, 6.32; 95% CI, 1.43-43.7; P = .01).
The CLI Frailty Index is a risk factor for 2-year AFS in CLI patients after revascularization. This result could prove useful for prognostic prediction and decision-making in selection of bypass surgery or endovascular therapy as a first treatment strategy.
目前尚不清楚衰弱是否会对严重肢体缺血（CLI）患者的治疗结果产生不利影响。本研究的目的是调查衰弱对CLI患者血管重建术后的影响。
对2007年至2015年间接受腘下血管重建术的患者进行回顾性分析。当患者出现以下两种或更多情况时被定义为CLI衰弱：老年营养风险指数低、骨骼肌质量指数低或非行走状态。主要研究终点是2年无截肢生存率（AFS）。为了分析衰弱的诊断标准，使用曲线下接受者操作特征面积将CLI衰弱指数与改良衰弱指数进行比较。次要终点是Clavien-Dindo IV级并发症的发生情况以及30天或住院死亡率。
在研究期间，266例患者和325条肢体接受了腘下血管重建术。CLI衰弱-组血管重建术后1年和2年的AFS率分别为81.8%和72.9%，而CLI衰弱+组分别为45.8%和34.0%（P <.001）。多变量分析显示，CLI衰弱指数（风险比[HR]，2.77；95%置信区间[CI]，1.78 - 4.32；P <.001）和血液透析（HR，1.72；95% CI，1.11 - 2.69；P =.02）是血管重建术后2年AFS的危险因素。CLI衰弱指数的曲线下面积为0.72，而改良衰弱指数为0.63（P =.01）。仅CLI衰弱指数被发现是发病（HR，3.21；95% CI，1.45 - 7.27；P =.004）和30天或住院死亡率（HR，6.32；95% CI，1.43 - 43.7；P =.01）的危险因素。
CLI衰弱指数是CLI患者血管重建术后2年AFS的危险因素。这一结果可能有助于预后预测以及在选择搭桥手术或血管内治疗作为首选治疗策略时进行决策。
