Association of the Naples Prognostic Score with Long-Term Adverse Events in Chronic Limb-Threatening Ischemia After Below-the-Knee Endovascular Revascularization.

OBJECTIVES

Chronic limb-threatening ischemia (CLTI) is the most severe manifestation of peripheral artery disease (PAD) and is associated with high morbidity and mortality. The Naples prognostic score (NPS), a composite marker incorporating serum albumin, total cholesterol, neutrophil-to-lymphocyte ratio (NLR), and lymphocyte-to-monocyte ratio (LMR), has shown prognostic value in various cardiovascular conditions. This study aimed to evaluate the prognostic significance of the NPS in predicting all-cause mortality and any kind of amputation in patients with CLTI undergoing endovascular treatment (EVT) for below-the-knee (BTK) lesions.

METHODS

In this retrospective analysis, 191 patients diagnosed with CLTI and treated with EVT for BTK lesions between 2017 and 2023 were stratified into three groups based on the NPS: low (0-1), intermediate (2), and high (3-4). The primary endpoint was all-cause mortality, while the secondary endpoint was any kind of amputation.

RESULTS

A higher NPS was significantly associated with increased all-cause mortality (hazard ratio: 3.66; 95% confidence interval: 1.72-7.78; < 0.001), while no significant association was observed between the NPS and major amputation. Independent predictors of mortality included a high NPS, reduced left ventricular ejection fraction, and impaired renal function.

CONCLUSIONS

The NPS is an independent predictor of long-term mortality in CLTI patients undergoing EVT for BTK lesions.