García-Rivera Elena, San Norberto Enrique M, Fidalgo-Domingos Liliana, Revilla-Calavia Álvaro, Estévez-Fernández Isabel, Cenizo-Revuelta Noelia, Martín-Pedrosa Miguel, Vaquero-Puerta Carlos
Department of Angiology and Vascular Surgery, Valladolid University Hospital, Valladolid, Spain.
Department of Angiology and Vascular Surgery, Valladolid University Hospital, Valladolid, Spain -
Int Angiol. 2021 Dec;40(6):504-511. doi: 10.23736/S0392-9590.21.04739-8. Epub 2021 Oct 12.
A pro-inflammatory state and a poor nutritional status have been associated with severity and prognosis of patients with peripheral arterial disease (PAD). The clinical applicability of the different pre-operative nutritional and inflammatory biomarkers in patients with critical limb-threatening ischemia (CLTI) was analyzed.
A retrospective observational study was performed, that included all patients with CLTI revascularized from January 2016 to July 2019. The inflammatory state was calculated using neutrophil/lymphocyte (NLR), lymphocyte/monocyte (LMR) and platelet/lymphocyte ratios (PLR). For nutritional status, the Prognostic Nutritional Index (PNI) was calculated. Mortality and number of major amputations at 6 months and hospital length-of stay were studied.
310 patients were included. Higher levels of NLR and lower levels of PNI were associated with mortality (6.61±5.6 vs. 3.98±3.27, P=0.034; 40.33±7.89 vs. 45.73±7.48, P=0.05, respectively). Lower levels of PNI and LMR (42.57±7.82 vs. 45.44±7.65, P=0.036; 2.77±1.61 vs. 3.22±1.75, P=0.013, respectively) and higher levels of NLR (6.91±7.85 vs. 3.94±2.57, P=0.023) were associated with major amputations. The mean hospital length-of-stay was higher in patients with lower levels of PNI and LMR (P=0.000 and P=0.003) and higher levels of NLR and PLR (P=0.001 and P=0.002). A PNI<42.87 predicted short-term mortality with a 66.7% of sensitivity and a 66.8% of specificity (P=0.000).
Our experience suggests that these inflammatory and nutritional biomarkers are independent predictors of short-term mortality and major amputations. In addition, our results suggest that PNI could be used to predict the short-term mortality with high sensitivity and specificity.
促炎状态和营养不良与外周动脉疾病（PAD）患者的病情严重程度及预后相关。分析了不同术前营养和炎症生物标志物在严重肢体缺血（CLTI）患者中的临床适用性。
进行了一项回顾性观察研究，纳入了2016年1月至2019年7月间所有接受血运重建的CLTI患者。使用中性粒细胞/淋巴细胞比值（NLR）、淋巴细胞/单核细胞比值（LMR）和血小板/淋巴细胞比值（PLR）计算炎症状态。计算预后营养指数（PNI）以评估营养状况。研究了6个月时的死亡率、大截肢数量和住院时间。
共纳入310例患者。较高的NLR水平和较低的PNI水平与死亡率相关（分别为6.61±5.6 vs. 3.98±3.27，P = 0.034；40.33±7.89 vs. 45.73±7.48，P = 0.05）。较低的PNI和LMR水平（分别为42.57±7.82 vs. 45.44±7.65，P = 0.036；2.77±1.61 vs. 3.22±1.75，P = 0.013）以及较高的NLR水平（6.91±7.85 vs. 3.94±2.57，P = 0.023）与大截肢相关。PNI和LMR水平较低（P = 0.000和P = 0.003）以及NLR和PLR水平较高（P = 0.001和P = 0.002）的患者平均住院时间更长。PNI < 42.87预测短期死亡率的敏感性为66.7%，特异性为66.8%（P = 0.000）。
我们的经验表明，这些炎症和营养生物标志物是短期死亡率和大截肢的独立预测因素。此外，我们的结果表明PNI可用于以高敏感性和特异性预测短期死亡率。
