Harrington Heart and Vascular Institute, University Hospitals Cleveland Medical Center, Cleveland, Ohio, USA.
School of Medicine, Case Western Reserve University, Cleveland, Ohio, USA.
Catheter Cardiovasc Interv. 2022 Jan 1;99(1):121-133. doi: 10.1002/ccd.29949. Epub 2021 Sep 19.
To assess geriatric nutritional risk index (GNRI) in patients with chronic limb-threatening ischemia (CLTI).
The prevalence of CLTI continues to rise, with major amputation and mortality remaining prominent. Frailty is a vital risk factor for adverse outcomes in cardiovascular care. The GNRI is a nutrition-based surrogate for frailty that has been utilized in Southeast Asia to predict adverse events in CLTI. It has not yet been evaluated in a primarily Western population, nor in the context of wound healing.
Between 8August 2017 and April 2019, we identified patients undergoing endovascular interventions for CLTI at our institution, categorized into low GNRI (≤ 94, frail) versus normal GNRI (> 94, reference). We analyzed the risks of major adverse limb events (MALE), its individual components [mortality, major amputation, and target vessel revascularization (TVR)], amputation free survival (AFS), and wound healing using Kaplan-Meier and multivariate cox-proportional hazard regression analyses.
A total of 255 patients were included in the analysis, with follow up of 14 ± 9.1 months. Lower GNRI was associated with higher cumulative event rates for MALE (71.0% vs. 43.3%, p < 0.001), mortality (34.3% vs. 15.2%, p < 0.001), major amputation (31.2% vs. 15.8%, p = 0.002), and freedom from AFS (56.0% vs. 28.2%, p < 0.001). There was a trend toward lower TVR and higher wound healing with higher GNRI score.
Our single-center, retrospective evaluation of GNRI (as a surrogate for frailty) correlated with increased risks of MALE, mortality, and major amputation. Future directions should focus not only on the recognition of these patients, but risk-factor modification to optimize long-term outcomes.
评估患有慢性肢体威胁性缺血（CLTI）的老年患者的营养风险指数（GNRI）。
CLTI 的患病率持续上升，主要截肢和死亡率仍然很高。衰弱是心血管护理不良结局的重要危险因素。GNRI 是一种基于营养的衰弱替代指标，已在东南亚用于预测 CLTI 的不良事件。它尚未在主要是西方人群中进行评估，也未在伤口愈合的背景下进行评估。
在 2017 年 8 月 8 日至 2019 年 4 月期间，我们在本院确定了接受 CLTI 血管内介入治疗的患者，将其分为低 GNRI（≤94，衰弱）与正常 GNRI（>94，参考）。我们使用 Kaplan-Meier 和多变量 Cox 比例风险回归分析来分析主要不良肢体事件（MALE）的风险，其各个组成部分[死亡率、主要截肢和靶血管血运重建（TVR）]、无截肢生存率（AFS）和伤口愈合。
共纳入 255 例患者进行分析，随访 14±9.1 个月。GNRI 较低与 MALE（71.0% vs. 43.3%，p<0.001）、死亡率（34.3% vs. 15.2%，p<0.001）、主要截肢（31.2% vs. 15.8%，p=0.002）和 AFS 无丢失（56.0% vs. 28.2%，p<0.001）的累积事件发生率较高相关。GNRI 评分较高与 TVR 较低和伤口愈合较高有关。
我们对 GNRI（作为衰弱的替代指标）的单中心回顾性评估与 MALE、死亡率和主要截肢的风险增加相关。未来的方向不仅应关注这些患者的识别，还应关注危险因素的修正，以优化长期结局。
