Department of Cardiology, Kafkas University Faculty of Medicine, Kars, Turkey.
Department of Cardiology, Kafkas University Faculty of Medicine, Kars, Turkey.
Ann Vasc Surg. 2024 May;102:121-132. doi: 10.1016/j.avsg.2023.11.028. Epub 2024 Feb 1.
Lower extremity peripheral artery disease (PAD) is the third most common clinical manifestation of atherosclerosis after coronary artery disease and stroke. Despite successful endovascular treatment (EVT), mortality and morbidity rates still remain higher in patients with PAD. Naples prognostic score (NPS) is a novel scoring system, reflects the patient's nutritional and immunological statuses as well as systemic inflammatory responses. In this study, we aimed to investigate the relationship between NPS and long-term outcomes in patients with PAD.
The population of this retrospective study consisted of 629 PAD patients who underwent EVT at Kafkas University Hospital between 2020 and 2023. For each patient, the NPS was calculated and then patients were divided into 3 groups based on their NPS. The primary end point of the study was the rate of major adverse cardiovascular (MACEs) and limb events (MALEs), that is, all-cause death or development of critical limb ischemia with consequent amputation.
Of a total of 629 patients, 62 were classified into group 0 (NPS 0), 315 into group 1 (NPS 1 or 2), and 252 into group 2 (NPS 3 or 4). The distribution of patients' baseline characteristics, angiographic features and MACEs and MALEs according to the NPS groups was analyzed. Significant adverse outcomes differences were observed among the 3 groups (P < 0.001). Multivariate logistic regression analysis revealed that age, diabetes mellitus, chronic kidney disease, lowest preprocedure ankle-brachial index, left ventricular ejection fraction and NPS (hazard ratio 1.916, 95% confidence interval [CI] 1.530-2.398, P < 0.001) were independent predictors of MACE whereas diabetes mellitus, presence of previous PAD, hemoglobin level, in-hospital acute thrombotic occlusion and NPS (odds ratio 1.963, 95% CI 1.489-2.588, P < 0.001) were independent predictors of MALE.
The inflammatory and nutritional state reflected by NPS levels was strongly associated with all-cause mortality and amputation after EVT in patients with PAD. Furthermore, NPS was found to be an independent predictor of these clinical outcomes.
下肢外周动脉疾病（PAD）是冠心病和中风之后第三大常见的动脉粥样硬化临床表现。尽管血管内治疗（EVT）取得了成功，但 PAD 患者的死亡率和发病率仍然较高。那不勒斯预后评分（NPS）是一种新的评分系统，反映了患者的营养和免疫状态以及全身炎症反应。在这项研究中，我们旨在研究 NPS 与 PAD 患者的长期预后之间的关系。
这项回顾性研究的人群包括 2020 年至 2023 年在卡法斯大学医院接受 EVT 的 629 名 PAD 患者。为每位患者计算 NPS，然后根据 NPS 将患者分为 3 组。研究的主要终点是主要不良心血管（MACE）和肢体事件（MALE）的发生率，即全因死亡或发生严重肢体缺血并随后截肢。
在总共 629 名患者中，62 名患者被归类为 NPS 0 组（NPS 0），315 名患者被归类为 NPS 1 或 2 组（NPS 1 或 2），252 名患者被归类为 NPS 3 或 4 组（NPS 3 或 4）。根据 NPS 组分析了患者基线特征、血管造影特征和 MACE 及 MALEs 的分布情况。3 组之间观察到显著的不良结局差异（P<0.001）。多变量逻辑回归分析显示，年龄、糖尿病、慢性肾脏病、最低术前踝肱指数、左心室射血分数和 NPS（危险比 1.916，95%置信区间[CI]1.530-2.398，P<0.001）是 MACE 的独立预测因素，而糖尿病、既往 PAD 存在、血红蛋白水平、住院期间急性血栓闭塞和 NPS（比值比 1.963，95%CI1.489-2.588，P<0.001）是 MALE 的独立预测因素。
NPS 水平反映的炎症和营养状态与 PAD 患者 EVT 后的全因死亡率和截肢密切相关。此外，NPS 被发现是这些临床结局的独立预测因素。
