Interdisciplinary Consortium on Advanced Motion Performance (iCAMP), Michael E. DeBakey Department of Surgery, Baylor College of Medicine, Houston, TX; Southwestern Academic Limb Salvage Alliance (SALSA), Department of Surgery, Keck School of Medicine of University of Southern California, Los Angeles, CA; Ulcer and wound Healing consortium (UHEAL), Queensland Research Centre for Peripheral Vascular Disease, College of Medicine and Dentistry, James Cook University, Townsville, Queensland, Australia; Faculty of Health and Medicine, School of Health Sciences, University of Newcastle, Australia.
Southwestern Academic Limb Salvage Alliance (SALSA), Department of Surgery, Keck School of Medicine of University of Southern California, Los Angeles, CA; Department of Human Kinetics and Podiatric Medicine, Université du Québec à Trois-Rivières, Trois-Rivières, Québec, Canada; VITAM-Centre de recherche en Santé durable, Québec, Québec, Canada.
Ann Vasc Surg. 2023 Feb;89:322-337. doi: 10.1016/j.avsg.2022.09.057. Epub 2022 Nov 2.
Frailty represents a state of multisystem impairment that may adversely impact people presenting with chronic limb-threatening ischemia (CLTI) and diabetes-related foot ulcers (DFUs). The aim of this systematic review was to explore the association between frailty and outcomes from CLTI and DFUs.
We performed a systematic literature search of electronic databases to find studies using a validated measure of frailty in individuals with CLTI and/or DFUs. The primary outcomes were the impact of frailty on the severity of initial clinical presentation and unfavorable follow-up outcomes including readmissions, major limb amputation, cardiovascular events, revascularization, and wound healing.
Ten cohort studies were included. Two studies had a low risk of bias, 1 was unable to be assessed, 5 had moderate risk of bias, and 2 high risk of bias. The prevalence of frailty in people presenting with CLTI ranged from 27% to 88% and was 71% in people with DFUs. The presence of frailty in both people with CLTI and DFUs was associated with substantially increased severity at presentation (severity of ischemia and tissue loss) and poorer outcomes at follow-up (risk of readmission, limb amputation, and all-cause mortality).
The presence of frailty in both people with CLTI and DFUs is likely associated with substantially higher complexity at presentation followed by a greater risk for readmission, amputation, and death during follow-up. Heterogeneity in the tools used to screen for frailty, poor definition of frailty, and unclear evaluation of exposure and outcomes limit further interpretation of findings.
衰弱代表一种多系统受损的状态，可能会对患有慢性肢体威胁性缺血（CLTI）和糖尿病相关足部溃疡（DFU）的患者产生不利影响。本系统评价的目的是探讨衰弱与 CLTI 和 DFU 结局之间的关系。
我们对电子数据库进行了系统文献检索，以找到使用 CLTI 和/或 DFU 个体的衰弱验证测量方法的研究。主要结局是衰弱对初始临床表现严重程度和不良随访结局（包括再入院、大肢体截肢、心血管事件、血运重建和伤口愈合）的影响。
共纳入 10 项队列研究。2 项研究的偏倚风险较低，1 项无法评估，5 项研究的偏倚风险为中度，2 项为高度。CLTI 患者中衰弱的患病率为 27%至 88%，DFU 患者中为 71%。CLTI 和 DFU 患者中衰弱的存在与初始表现时严重程度（缺血和组织损失的严重程度）显著增加以及随访时结局较差（再入院、截肢和全因死亡率的风险）相关。
CLTI 和 DFU 患者中衰弱的存在可能与初始表现时的复杂性显著增加相关，随后在随访期间再入院、截肢和死亡的风险增加。用于筛查衰弱的工具存在异质性、衰弱的定义不佳以及暴露和结局的评估不明确，限制了对研究结果的进一步解释。
