控制营养状况评分对腔内治疗后慢性肢体严重缺血患者伤口愈合的影响。

Impact of Controlling a Nutritional Status Score on Wound Healing in Patients with Chronic Limb-Threatening Ischemia after Endovascular Treatment.

机构信息

Department of Cardiology, Fukuoka University School of Medicine, 7-45-1 Nanakuma, Jonan-Ku, Fukuoka 814-0180, Japan.

Division of Cardiology, Fukuoka University Nishijin Hospital, Fukuoka 814-8522, Japan.

出版信息

Nutrients. 2021 Oct 22;13(11):3710. doi: 10.3390/nu13113710.

BACKGROUND

Chronic limb-threatening ischemia (CLTI) is the most advanced stage of peripheral artery disease. Therefore, a multidisciplinary approach is necessary to avoid major amputation in CLTI patients. Malnutrition worsens the condition of CLTI patients, and therefore, it may be important to evaluate the nutritional status in patients with CLTI. This study was designed to evaluate the baseline patient characteristics and the influence of the controlling nutritional status (CONUT) score on the clinical results.

METHOD AND RESULTS

A retrospective, single-center, non-randomized study was conducted to evaluate the associations of death, major amputation, and wound healing rate at 12 months with the CONUT score on admission. Consecutive CLTI patients (mean age 73.2 ± 10.4 years; 84 males) who underwent endovascular therapy (EVT) for infra-popliteal lesions at Fukuoka University Hospital from January 2014 to May 2019 were enrolled and divided into two groups (higher and lower CONUT score groups). The higher CONUT group showed a higher percentage of dialysis (66.7% vs. 33.9%, < 0.001) and a higher clinical frailty scale (5.9 ± 1.4 vs. 4.9 ± 1.9, = 0.005) than the lower CONUT group. Rates of amputation-free survival were 89.5% and 69.8% in the lower and higher CONUT groups, respectively. In addition, rates of wound healing at 12 months were 98.0% and 78.3% in the lower and higher CONUT groups, respectively. Multivariate regression analysis demonstrated that a higher CONUT score was an independent predictor for delayed wound healing (OR: 11.2; 95% CI: 1.29-97.5; = 0.028).

CONCLUSION

An assessment of the nutritional status using the CONUT score could be useful for predicting wound healing, and earlier nutritional intervention may improve the outcome of CLTI patients. Early examination and treatment, along with raising awareness of the issue, may be important for improving the prognosis.

背景

慢性肢体威胁性缺血（CLTI）是外周动脉疾病的最严重阶段。因此，需要多学科方法来避免 CLTI 患者进行大截肢。营养不良会使 CLTI 患者的病情恶化，因此，评估 CLTI 患者的营养状况可能很重要。本研究旨在评估基线患者特征以及 CONUT 评分对临床结果的影响。

方法和结果

进行了一项回顾性、单中心、非随机研究，以评估入院时 CONUT 评分与 12 个月时死亡、大截肢和伤口愈合率之间的相关性。2014 年 1 月至 2019 年 5 月，在福冈大学医院接受腔内治疗（EVT）治疗下肢动脉病变的连续 CLTI 患者（平均年龄 73.2±10.4 岁；84 名男性）入组并分为两组（CONUT 评分较高组和较低组）。CONUT 评分较高组的透析比例（66.7%比 33.9%，<0.001）和临床虚弱评分（5.9±1.4 比 4.9±1.9， =0.005）更高。CONUT 评分较低组的无截肢生存率为 89.5%，CONUT 评分较高组为 69.8%。此外，CONUT 评分较低组的伤口愈合率为 12 个月时的 98.0%，CONUT 评分较高组为 78.3%。多变量回归分析表明，较高的 CONUT 评分是伤口愈合延迟的独立预测因子（OR：11.2；95%CI：1.29-97.5； =0.028）。