Tseng Hsinyu, Liao Min-Tsun, Keng Li-Ta, Chang Chia-Hao, Zeng Ya-Zih, Hsieh Mu-Yang
Cardiovascular Center.
Division of Cardiology, Department of Medicine.
Acta Cardiol Sin. 2024 Sep;40(5):627-634. doi: 10.6515/ACS.202409_40(5).20240528A.
Lower extremity peripheral artery disease (LE-PAD) has been linked to unfavorable cardiovascular outcomes. The impact of potentially undiagnosed LE-PAD, suspected by abnormal ankle-brachial index (ABI), on the survival of sepsis patients admitted to the intensive care unit (ICU) remains uncertain.
We conducted a prospective cohort study and recruited adult patients admitted to the ICU with a primary diagnosis of sepsis (defined by a quick Sepsis-Related Organ Failure Assessment score of ≥ 2) between November 23, 2017 and July 22, 2018. ABI measurements were obtained within 24 hours of admission. The study compared the 30-day and 1-year all-cause mortality rates as well as the incidence of major adverse cardiovascular events (MACEs) between the groups with normal and abnormal ABI values.
Of the 102 sepsis patients admitted to the ICU, 38 (37%) were diagnosed with LE-PAD based on their ABI measurements. The overall 30-day mortality rate was 30.0% in patients with LE-PAD and 25.8% in those with normal ABI (p = 0.56). At 1 year, the overall mortality rate was 52.6% in the patients with abnormal ABI and 40.6% in those with normal ABI (p = 0.24). Additionally, the incidence of MACEs was significantly higher in the patients with abnormal ABI compared to those with normal ABI at 1-year follow-up (21.1% vs. 3.1%, respectively; p = 0.003).
The patients with abnormal ABI had a higher incidence of MACEs within one year following hospital discharge. Future studies are needed to improve cardiovascular outcomes among sepsis survivors (ClinicalTrials.gov number, NCT03372330).
下肢外周动脉疾病（LE-PAD）与不良心血管结局相关。通过异常踝臂指数（ABI）怀疑存在的潜在未确诊LE-PAD对入住重症监护病房（ICU）的脓毒症患者生存的影响仍不确定。
我们进行了一项前瞻性队列研究，纳入了2017年11月23日至2018年7月22日期间入住ICU且初步诊断为脓毒症（根据快速脓毒症相关器官功能衰竭评估评分≥2定义）的成年患者。入院后24小时内进行ABI测量。该研究比较了ABI值正常和异常组之间的30天和1年全因死亡率以及主要不良心血管事件（MACE）的发生率。
在入住ICU的102例脓毒症患者中，38例（37%）根据ABI测量被诊断为LE-PAD。LE-PAD患者的总体30天死亡率为30.0%，ABI正常患者为25.8%（p = 0.56）。1年时，ABI异常患者的总体死亡率为52.6%，ABI正常患者为40.6%（p = 0.24）。此外，在1年随访时，ABI异常患者的MACE发生率显著高于ABI正常患者（分别为21.1%和3.1%；p = 0.003）。
ABI异常的患者出院后1年内MACE发生率较高。需要进一步研究以改善脓毒症幸存者的心血管结局（ClinicalTrials.gov编号，NCT03372330）。
