Department of Cardiovascular Medicine and Hypertension, Graduate School of Medical and Dental Sciences, Kagoshima University, Kagoshima, Japan.
Vascular. 2023 Jun;31(3):504-512. doi: 10.1177/17085381221076943. Epub 2022 Feb 28.
The Wound, Ischemia, and foot Infection (WIfI) clinical stage has been thought to have a prognostic value in Chronic limb-threatening ischemia (CLTI) patients, and frailty and nutritional status appear to represent pivotal factor affecting prognosis among CLTI patients. The purpose of this study was to examine clinical factors (including frailty and nutritional status) relevant to WIfI clinical stage.
This retrospective study investigated 200 consecutive CLTI patients. We individually assessed WIfI clinical stage, frailty according to the Clinical Frailty Scale (CFS) score, and malnutrition according to Geriatric Nutritional Risk Index (GNRI). We then compared mortality after endovascular intervention between a WIfI stage 1, 2 group and a stage 3, 4 group, and investigated associations between baseline characteristics (including CFS and GNRI) and WIfI clinical stage.
Among 200 patients, 123 patients (62%) showed WIfI stage 1 or 2, and the remaining 77 patients (38%) had WIfI stage 3 or 4. CFS score was significantly higher in the WIfI stage 3, 4 group [median 6.0, interquartile range (IQR) 5.5-7.0] compared with the WIfI stage 1, 2 group (median 5.0, IQR 4.0-6.0, < 0.001), and GNRI was significantly lower in the WIfI stage 3, 4 group (median 88, IQR 80-97) than in the WIfI stage 1, 2 (median 103, IQR 94-111, < 0.001). Forty patients (20%) died after endovascular intervention. Incidences of all-cause and cardiac deaths were higher in the WIfI stage 3, 4 group than in the WIfI stage 1, 2 group (27% vs. 15%, = 0.047 and 12% vs. 3%, = 0.040, respectively). Kaplan-Meier analysis showed a significantly lower survival rate in the WIfI stage 3, 4 group than in the WIfI stage 1, 2 group ( = 0.002 by log-rank test). Multivariate logistic regression analysis using relevant factors from univariate analysis showed CFS score [odds ratio (OR) 2.06, 95% confidence interval (CI) 1.41-3.13, < 0.001), diabetes mellitus (OR 3.17, 95%CI 1.17-8.61, = 0.023) and GNRI (OR 0.93, 95%CI 0.89-0.97, = 0.002) significantly associated with WIfI stage 3 or 4. In addition, multivariate ordinal logistic regression analysis for WIfI clinical stage showed CFS score (OR 1.43, 95%CI 1.09-1.89, = 0.011), diabetes mellitus (OR 1.77, 95%CI 1.26-2.54, < 0.001), and high-sensitivity C-reactive protein (OR 1.14, 95%CI 1.02-1.28, = 0.041) were positively associated with WIfI clinical stage, and GNRI correlated negatively with WIfI clinical stage (OR 0.95, 95%CI 0.91-0.97, < 0.001).
These results indicate that CLTI patients with high WIfI clinical stage may be more frail and malnourished, and be associated with poor prognosis after endovascular intervention.
伤口、缺血和足部感染（WIfI）临床分期被认为对慢性肢体威胁性缺血（CLTI）患者具有预后价值，而虚弱和营养状况似乎是影响 CLTI 患者预后的关键因素。本研究旨在探讨与 WIfI 临床分期相关的临床因素（包括虚弱和营养状况）。
本回顾性研究调查了 200 例连续的 CLTI 患者。我们分别评估了 WIfI 临床分期、根据临床虚弱量表（CFS）评分评估的虚弱程度以及根据老年营养风险指数（GNRI）评估的营养不良程度。然后，我们比较了血管内介入治疗后 WIfI 分期 1 、 2 组和分期 3 、 4 组之间的死亡率，并调查了基线特征（包括 CFS 和 GNRI）与 WIfI 临床分期之间的关系。
在 200 例患者中，123 例（62%）表现为 WIfI 分期 1 或 2，其余 77 例（38%）为 WIfI 分期 3 或 4。WIfI 分期 3 、 4 组的 CFS 评分[中位数 6.0，四分位距（IQR）5.5-7.0]明显高于 WIfI 分期 1 、 2 组[中位数 5.0，IQR 4.0-6.0， < 0.001]，而 WIfI 分期 3 、 4 组的 GNRI 明显低于 WIfI 分期 1 、 2 组[中位数 88，IQR 80-97]比 WIfI 分期 1 、 2 （中位数 103，IQR 94-111， < 0.001）。40 例（20%）患者在血管内介入治疗后死亡。WIfI 分期 3 、 4 组的全因死亡率和心脏死亡率均高于 WIfI 分期 1 、 2 组（27% vs. 15%，= 0.047 和 12% vs. 3%，= 0.040）。Kaplan-Meier 分析显示 WIfI 分期 3 、 4 组的生存率明显低于 WIfI 分期 1 、 2 组（log-rank 检验= 0.002）。单因素分析后采用多因素逻辑回归分析显示 CFS 评分[比值比（OR）2.06，95%置信区间（CI）1.41-3.13， < 0.001）、糖尿病（OR 3.17，95%CI 1.17-8.61， = 0.023）和 GNRI（OR 0.93，95%CI 0.89-0.97， < 0.001）与 WIfI 分期 3 或 4 显著相关。此外，WIfI 临床分期的多因素有序逻辑回归分析显示 CFS 评分（OR 1.43，95%CI 1.09-1.89， = 0.011）、糖尿病（OR 1.77，95%CI 1.26-2.54， < 0.001）和高敏 C 反应蛋白（OR 1.14，95%CI 1.02-1.28， = 0.041）与 WIfI 临床分期呈正相关，而 GNRI 与 WIfI 临床分期呈负相关（OR 0.95，95%CI 0.91-0.97， < 0.001）。
这些结果表明，CLTI 患者 WIfI 临床分期较高可能更虚弱和营养不良，并与血管内介入治疗后预后不良相关。
