Tokuda Takahiro, Hirano Keisuke, Yamawaki Masahiro, Araki Motoharu, Kobayashi Norihiro, Sakamoto Yasunari, Mori Shisuke, Tsutsumi Masakazu, Honda Yosuke, Ito Yoshiaki
1 Department of Cardiovascular Medicine, Saiseikai Yokohama City Eastern Hospital, Yokohama, Kanagawa, Japan.
Vasc Endovascular Surg. 2018 Aug;52(6):411-417. doi: 10.1177/1538574418770849. Epub 2018 Apr 22.
Certain patients with critical limb ischemia (CLI) experience significant decline in activities of daily living (ADL) during hospitalization. The prognosis of decline in ADL during hospitalization remains unknown.
A retrospective analysis was performed on collected data of patients with CLI treated by endovascular treatment between April 2007 and December 2015. We evaluated CLI in patients ADL at the time of hospitalization and after discharge using the Barthel index. We classified all patients into patients with decline in ADL and stable in ADL and compared clinical outcomes (cumulative incidence of wound healing, amputation-free survival at 1 year) between the 2 groups.
Two hundred and fifty-five consecutive patients with CLI (221 limbs), who underwent successful endovascular intervention, were enrolled in this study. Of all patients, 22 patients were classified into the decline group. The prevalence of wound, Ischemia, foot infection (WIfI) classification high grade was higher in the decline group (30.7% vs 63.6%; P < .01). The wound healing rates were worse in the decline group than in the stable group (40% vs 78% at 1 year; P < .01). The same trends were observed in the amputation-free survival (37% vs 78%; P < .01). After multivariate analysis, decline in ADL was an independent predictor of wound healing and amputation-free survival (odds ratio [OR]: 2.85, 95% confidence interval [CI]: 1.61-3.35, P < .01; OR: 2.46, 95% CI: 1.26-4.53, P = .01).
Patients with CLI with decline in ADL during hospitalization were found to have a poor prognosis suggesting that a decline in ADL may affect the clinical outcomes.
部分严重肢体缺血（CLI）患者在住院期间日常生活活动能力（ADL）显著下降。住院期间ADL下降的预后情况尚不清楚。
对2007年4月至2015年12月期间接受血管内治疗的CLI患者收集的数据进行回顾性分析。我们使用Barthel指数评估患者住院时及出院后的ADL情况。我们将所有患者分为ADL下降组和ADL稳定组，并比较两组的临床结局（伤口愈合的累积发生率、1年无截肢生存率）。
本研究纳入了255例连续接受成功血管内介入治疗的CLI患者（221条肢体）。所有患者中，22例被分类为下降组。下降组中伤口、缺血、足部感染（WIfI）分类高级别的患病率更高（30.7%对63.6%；P <.01）。下降组的伤口愈合率比稳定组更差（1年时分别为40%对78%；P <.01）。在无截肢生存率方面也观察到相同趋势（37%对78%；P <.01）。多因素分析后，ADL下降是伤口愈合和无截肢生存的独立预测因素（优势比[OR]：2.85，95%置信区间[CI]：1.61 - 3.35，P <.01；OR：2.46，95%CI：1.26 - 4.53，P =.01）。
住院期间ADL下降的CLI患者预后较差，提示ADL下降可能影响临床结局。
