Cao Zhanjiang, Li Zipeng, Yu Xiaohua, Li Yiwen, Li Jiazheng, Bai Luhuan, Wu Weiwei
Department of Vascular Surgery, Beijing Tsinghua Changgung Hospital, School of Clinical Medicine, Tsinghua University, Beijing, China.
Department of Vascular Surgery, Beijing Tsinghua Changgung Hospital, School of Clinical Medicine, Tsinghua University, Beijing, China.
Ann Vasc Surg. 2025 Jan;110(Pt B):386-394. doi: 10.1016/j.avsg.2024.07.103. Epub 2024 Aug 7.
Chronic limb-threatening ischemia (CLTI) represents the severest manifestation of peripheral artery disease. Malnutrition is closely associated with poor clinical outcomes in patients with chronic diseases. The Controlling Nutritional Status (CONUT) score is a tool to evaluate the systemic inflammation and nutritional status. This study aimed to investigate the association of baseline CONUT score with mortality in patients with CLTI following endovascular revascularization.
A single-center retrospective analysis of patients with CLTI undergoing endovascular revascularization between January 2015 and December 2022 was performed. Preoperative nutritional status was evaluated using CONUT score, which was calculated using the serum albumin concentration, total peripheral lymphocyte count, and total cholesterol concentration. A CONUT score ≥5 indicates moderate or severe malnutrition. The Kaplan-Meier and multivariate Cox proportional hazards regression were used for survival analysis and to evaluate the risk factors associated with mortality.
Among 232 enrolled patients, 20.7% had moderate or severe malnutrition defined by the CONUT score. During a median follow-up of 2.1 (interquartile ranges, 1.0-3.5) years, 87 (37.5%) patients died. The 3-year overall survival rate in patients with CLTI who underwent endovascular revascularization was 63.7%. The high CONUT (≥5) group had significantly worse 3-year overall survival (42.0% vs. 68.8%, P = 0.004) and limb salvage (73.3% vs. 84.1%, P = 0.005) rates than the low CONUT (<5) group. Multivariate analysis showed that high CONUT score was significantly associated with increased risk for mortality in patients with CLTI after endovascular revascularization (hazard ratio, 1.687; 95% confidence interval, 1.031-2.759; P = 0.037).
The present study indicated that moderate or severe malnutrition defined by the CONUT score was significantly associated with increased mortality in patients with CLTI following endovascular revascularization. Future study is required to evaluate the efficacy of nutritional intervention in these patients.
慢性肢体威胁性缺血（CLTI）是外周动脉疾病最严重的表现形式。营养不良与慢性病患者不良的临床结局密切相关。控制营养状况（CONUT）评分是一种评估全身炎症和营养状况的工具。本研究旨在探讨基线CONUT评分与CLTI患者血管腔内血运重建术后死亡率之间的关联。
对2015年1月至2022年12月期间接受血管腔内血运重建术的CLTI患者进行单中心回顾性分析。术前营养状况采用CONUT评分进行评估，该评分通过血清白蛋白浓度、外周血淋巴细胞总数和总胆固醇浓度计算得出。CONUT评分≥5表明存在中度或重度营养不良。采用Kaplan-Meier法和多变量Cox比例风险回归进行生存分析，并评估与死亡率相关的危险因素。
在232例纳入研究的患者中，20.7%的患者根据CONUT评分存在中度或重度营养不良。在中位随访2.1（四分位间距，1.0 - 3.5）年期间，87例（37.5%）患者死亡。接受血管腔内血运重建术的CLTI患者3年总生存率为63.7%。CONUT评分高（≥5）组的3年总生存率（42.0%对68.8%，P = 0.004）和肢体挽救率（73.3%对84.1%，P = 0.005）显著低于CONUT评分低（<5）组。多变量分析显示，CONUT评分高与CLTI患者血管腔内血运重建术后死亡风险增加显著相关（风险比，1.687；95%置信区间，1.031 - 2.759；P = 0.037）。
本研究表明，CONUT评分定义的中度或重度营养不良与CLTI患者血管腔内血运重建术后死亡率增加显著相关。未来需要开展研究评估这些患者营养干预的疗效。
