School of Medicine, Antenor Orrego Private University, Trujillo 13007, Peru.
School of Medicine, Antenor Orrego Private University, Trujillo 13007, Peru; Surgery Department, Alta Complejidad Virgen de la Puerta Hospital, Essalud, Trujillo 13007, Peru.
J Med Vasc. 2022 Jul-Aug;47(3):116-124. doi: 10.1016/j.jdmv.2022.07.002. Epub 2022 Aug 2.
Demonstrate that simplified ERICVA (Valladolid Critical Limb Ischaemia Risk Scale) is useful in predicting amputation in chronic limb-threatening ischemia (CLI) after one year of revascularization.
A retrospective cohort study was performed. We analyzed the medical records of 93 patients over the age of 35 with the diagnosis of CLI who were treated in the Department of Internal Medicine, Orthopedics or in the Cardiovascular Surgery Unit of the Víctor Lazarte Echegaray Hospital and the High Complexity Virgen de La Puerta Hospital during the period 2015-2018. The simplified ERICVA score was determined in patients before surgical and endovascular revascularization. We included 31 patients who scored 2 or more points in the exposed group and 62 patients who scored less than 2 points in the group not exposed to amputation risk. The collected data was analyzed with the statistical program SPSS where the Relative Risk and significance was obtained with Pearson's Chi-square. The multivariate analysis was also carried out in order to obtain the adjusted relative risk.
It was identified that the simplified ERICVA score greater than or equal to 2 points was more frequent in those who underwent amputation (90.3%) compared to patients who did not undergo amputation (4.8%), increasing the risk of amputation in those patients with CLI who underwent revascularization (RR: 18.67, P<0.001). It was also possible to identify that within the group of patients that showed a high risk of amputation according to the ERICVA scale, they had a higher risk of major amputation (RR: 9.32, P<0.001) as opposed to the risk of minor amputation (RR: 1, 89, P=0.193). Among the items of the simplified ERICVA scale, the preoperative neutrophil-lymphocyte ratio and hematocrit were significantly higher in the group of amputated patients (P<0.001). In addition, it was possible to identify that the score greater than or equal to 2 was independently associated with the risk of amputation in patients revascularized with CLI (RR: 13.5, P<0.001).
In our patient population, the simplified ERICVA scale is useful in predicting major and minor amputation in critical limb ischemia after revascularization. The present data showed that the patients who had a simplified ERICVA score greater than or equal to 2 had a higher risk of major amputation compared to the risk of minor amputation. However, it is important to highlight that the impact on the prediction of minor amputation is greater because in some circumstances major amputation can appear as a complication of CLI.
证明简化版 ERICVA（巴利亚多利德肢体严重缺血风险评分）在预测血管重建后慢性肢体威胁性缺血（CLI）患者一年后截肢方面具有一定作用。
本研究为回顾性队列研究。我们分析了 2015 年至 2018 年间在瓦拉达理德·埃切加雷医院内科、骨科或心血管外科部门就诊的 93 名年龄超过 35 岁的 CLI 诊断患者的医疗记录。在接受手术和血管内血运重建之前，确定了简化版 ERICVA 评分。我们将 31 名评分≥2 分的患者纳入暴露组，62 名评分<2 分的患者纳入未暴露于截肢风险组。使用统计程序 SPSS 分析收集的数据，使用 Pearson 卡方获得相对风险和显著性。还进行了多变量分析，以获得调整后的相对风险。
在接受截肢的患者中，简化版 ERICVA 评分≥2 分更为常见（90.3%），而未接受截肢的患者为 4.8%，这增加了 CLI 患者血管重建后截肢的风险（RR：18.67，P<0.001）。还可以发现，根据 ERICVA 评分，在显示高截肢风险的患者组中，他们有更高的主要截肢风险（RR：9.32，P<0.001），而不是小截肢风险（RR：1，89，P=0.193）。在简化版 ERICVA 评分的项目中，截肢患者的术前中性粒细胞-淋巴细胞比值和红细胞压积明显更高（P<0.001）。此外，还可以发现，在 CLI 血管重建患者中，评分≥2 与截肢风险独立相关（RR：13.5，P<0.001）。
在我们的患者群体中，简化版 ERICVA 评分可用于预测血管重建后 CLI 患者的大、小截肢。本研究数据显示，简化版 ERICVA 评分≥2 的患者发生大截肢的风险高于小截肢的风险。然而，值得强调的是，其对小截肢的预测影响更大，因为在某些情况下，大截肢可能是 CLI 的并发症。
