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血管内治疗后慢性肢体威胁性缺血患者的出院目的地与中期死亡率之间的关联:DENEB研究结果

Association between discharge destination and medium-term mortality in patients with chronic limb-threatening ischemia after endovascular therapy: results of the DENEB study.

作者信息

Yoshioka Naoki, Tokuda Takahiro, Tanaka Akiko, Kojima Shunsuke, Yamaguchi Kohei, Yanagiuchi Takashi, Ogata Kenji, Takei Tatsuro, Morita Yasuhiro, Nakama Tatsuya, Morishima Itsuro

机构信息

Department of Cardiology, Ogaki Municipal Hospital, 4-86 Minaminokawa-cho Ogaki, Gifu, Japan.

Department of Cardiology, Nagoya Heart Center, Nagoya, Japan.

出版信息

Heart Vessels. 2025 Sep 16. doi: 10.1007/s00380-025-02599-3.

Abstract

Owing to the aging population, patients are increasingly undergoing endovascular therapy (EVT) for chronic limb-threatening ischemia (CLTI). CLTI onset causes patients to become increasingly frail and less able to perform daily activities, preventing their discharge home. However, the association of discharge destination with clinical backgrounds and outcomes in these patients has not been fully evaluated. In this study, data from 606 patients with CLTI who underwent EVT between March 2021 and December 2023 and survived to discharge were obtained from a multicenter registry (mean age, 74.5 years; 61.4% men). Non-home discharge was defined as transfer to another hospital or nursing home. Logistic regression analysis was used to identify independent predictors of non-home discharge. Mortality rates within two years of discharge were compared between the home and non-home discharge groups. Of the 606 patients, 108 underwent non-home discharge. Multivariate analysis identified mild frailty (odds ratio [OR] 2.32, 95% confidence interval [CI] 1.34-4.02, p = 0.003), advanced frailty (OR 3.50, 95% CI 1.95-6.28, p < 0.001), a Hemoglobin level < 11 g/dL (OR 1.87, 95% CI 1.15-3.02, p = 0.011), and a Wound, Ischemia, and Foot Infection grade 4 (OR 7.27, 95% CI 2.16-24.46, p = 0.001) as significant predictors of non-home discharge. During the two-year follow-up period, 161 patients died. Cumulative all-cause mortality was significantly higher in the non-home discharge group than in the home discharge group (58.6% vs. 33.7%; log-rank p < 0.001). The findings of this study reveal that non-home discharge occurred in one-sixth of patients with CLTI undergoing EVT, and was linked to a more severe clinical status and worse prognosis than home discharge.

摘要

由于人口老龄化,慢性肢体威胁性缺血(CLTI)患者越来越多地接受血管内治疗(EVT)。CLTI的发作使患者日益虚弱,日常活动能力下降,导致他们无法出院回家。然而,这些患者的出院目的地与临床背景和预后之间的关联尚未得到充分评估。在本研究中,从一个多中心登记处获取了2021年3月至2023年12月期间接受EVT并存活至出院的606例CLTI患者的数据(平均年龄74.5岁;男性占61.4%)。非回家出院定义为转至另一家医院或疗养院。采用逻辑回归分析确定非回家出院的独立预测因素。比较了回家出院组和非回家出院组出院后两年内的死亡率。在606例患者中,108例接受了非回家出院。多变量分析确定轻度虚弱(比值比[OR]2.32,95%置信区间[CI]1.34 - 4.02,p = 0.003)、重度虚弱(OR 3.50,95%CI 1.95 - 6.28,p < 0.001)、血红蛋白水平<11 g/dL(OR 1.87,95%CI 1.15 - 3.02,p = 0.011)和伤口、缺血和足部感染4级(OR 7.27,95%CI 2.16 - 24.46,p = 0.001)是非回家出院的显著预测因素。在两年的随访期内,161例患者死亡。非回家出院组的累积全因死亡率显著高于回家出院组(58.6%对33.7%;对数秩检验p < 0.001)。本研究结果表明,接受EVT的CLTI患者中有六分之一发生非回家出院,且与回家出院相比,临床状况更严重,预后更差。

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