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Elevated Composite Inflammatory Markers are Associated with Clinical Severity and Long-term Amputation Risk in Patients with Critical Limb Ischemia after Percutaneous Transluminal Angioplasty Cover

Elevated Composite Inflammatory Markers are Associated with Clinical Severity and Long-term Amputation Risk in Patients with Critical Limb Ischemia after Percutaneous Transluminal Angioplasty

Journal of Cardiovascular Emergencies
Volume 10 (2024): Issue 3 (September 2024)
By:
Open Access
|Sep 2024

Figures & Tables

FIGURE 1.

Graphical representation of the differences in SII (A), SIRI (B), and AISI (C) inflammatory biomarker values between patients with stage III and stage IV according to the Leriche-Fontaine classification
Graphical representation of the differences in SII (A), SIRI (B), and AISI (C) inflammatory biomarker values between patients with stage III and stage IV according to the Leriche-Fontaine classification

FIGURE 2.

Graphical representation of the differences in SII (A), SIRI (B), and AISI (C) inflammatory biomarker values between patients with and without major amputation during follow-up
Graphical representation of the differences in SII (A), SIRI (B), and AISI (C) inflammatory biomarker values between patients with and without major amputation during follow-up

FIGURE 3.

Kaplan–Meier graph showing the incidence of major amputation during follow-up, categorized by the median values of SII (A), SIRI (B), and AISI (C)
Kaplan–Meier graph showing the incidence of major amputation during follow-up, categorized by the median values of SII (A), SIRI (B), and AISI (C)

ROC analysis for predicting clinical severity and major amputation

VariablesCut-offAUCStd. error95% CISensitivitySpecificityp value
Stage IV Leriche-Fontaine
SII–0.6330.0570.492–0.715––0.052
SIRI1.680.6980.0530.594–0.80377.2%52.4%<0.001*
AISI362.250.6800.0550.572–0.78780.7%50.0%0.001*
Major amputation
SII961.680.7310.0670.600–0.86281.3%69.9%0.001*
SIRI1.490.7120.0600.595–0.82993.8%42.2%<0.001*
AISI395.680.6980.0670.568–0.82987.5%47.0%0.003*

Patient characteristics by clinical severity

VariablesAll patients n = 104Stage III Leriche-Fontaine n = 44Stage IV Leriche-Fontaine n = 60p value
Age, years, mean ± s.d.70.59 ± 9.1368.86 ± 7.6271.86 ± 9.960.081
Male, n (%)81 (77.88%)33 (75.00%)48 (80.00%)0.794
Comorbidities and risk factors, n (%)
Hypertension90 (86.53%)38 (86.36%)52 (86.67%)0.133
Ischemic heart disease61 (58.65%)21 (47.72%)40 (66.67%)0.305
Chronic heart failure42 (40.38%)14 (31.81%)28 (46.66%)0.127
Atrial fibrillation12 (11.54%)3 (6.81%)9 (15.0%)0.197
Cardiovascular events13 (12.50%)4 (9.09%)9 (15.0%)0.368
Cerebrovascular events14 (13.46%)4 (9.09%)10 (16.67%)0.263
Diabetes mellitus63 (60.57%)23 (52.27%)40 (66.67%)0.529
Varicose veins11 (10.57%)4 (9.09%)7 (11.67%)0.673
Obesity26 (25.0%)9 (20.45%)17 (28.33%)0.359
Active smoking50 (48.07%)21 (47.72%)29 (48.33%)0.951
Dyslipidemia49 (47.11%)18 (40.91%)31 (51.67%)0.278
Laboratory data, mean ± s.d.
Hemoglobin, g/dl12.62 ± 1.8613.07 ± 1.7512.28 ± 1.890.030*
Hematocrit, %38.16 ± 5.2298.29 ± 4.5337.33 ± 5.560.098
Leukocytes, × 103/µl9.44 ± 3.098.45 ± 2.6910.17 ± 3.190.005*
BUN, mg/dl45.05 ± 24.9738.61 ± 12.7349.39 ± 29.910.163
Creatinine, mg/dl1.31 ± 1.520.98 ± 0.291.55 ± 1.960.829
eGFR, ml/min/1.73 m282.20 ± 31.9183.16 ± 24.8781.48 ± 36.520.813
Glucose, mg/dl132.33 ± 58.99128.83 ± 50.75134.91 ± 64.720.840
AST, U/L19.83 ± 8.4120.56 ± 9.1019.30 ± 7.920.580
ALT, U/L19.74 ± 11.6020.28 ± 10.8419.34 ± 12.210.439
Neutrophils, × 103/µl6.67 ± 2.795.70 ± 2.167.38 ± 3.010.002*
Lymphocytes, × 103/µl2.04 ± 1.481.93 ± 0.692.12 ± 1.860.840
Monocytes, × 103/µl0.73 ± 0.310.62 ± 0.290.79 ± 0.29<0.001*
PLT, × 103/µl271.60 ± 105.54258.35 ± 75.25281.37 ± 122.960.671
INR1.18 ± 0.351.19 ± 0.371.17 ± 0.330.461
aPTT28.83 ± 11.3628.50 ± 12.8429.12 ± 10.040.465
Major amputation, n (%)16 (15.38%)6 (13.63%)10 (16.67%)0.672
Mortality, n (%)13 (12.50%)3 (6.81%)9 (15.0%)0.134
Follow-up period, years, mean ± s.d.1.26 ± 0.811.32 ± 0.841.22 ± 0.790.785
Length of stay, days, mean ± s.d.6.17 ± 4.136.02 ± 4.086.28 ± 4.200.782

Characteristics of atherosclerotic lesions of the infrainguinal arteries at preoperative CTA

Variables All patients n = 104Stage III Leriche-Fontaine n = 44Stage IV Leriche-Fontaine n = 60p value
Superficial femoral artery70–90%10 (9.61%)4 (9.09%)6 (10.0%)0.877
90–99%14 (13.46%)7 (15.91%)7 (11.66%)0.531
Occlusion17 (16.34%)10 (22.72%)7 (11.66%)0.132
Popliteal artery70–90%6 (5.76%)2 (4.54%)4 (6.67%)0.647
90–99%12 (11.53%)7 (15.91%)5 (8.33%)0.232
Occlusion13 (12.5%)2 (4.54%)11 (18.33%)0.036*
Anterior tibial artery70–90%3 (2.88%)-3 (5.0%)0.132
90–99%10 (9.61%)1 (2.27%)9 (15.0%)0.007*
Occlusion28 (26.92%)10 (22.72%)18 (30.0%)0.409
Posterior tibial artery70–90%2 (1.92%)-2 (3.33%)0.221
90–99%8 (7.69%)1 (2.27%)7 (11.66%)0.076
Occlusion34 (32.69%)10 (22.72%)24 (40.0%)0.064
Peroneal artery70–90%3 (2.88%)1 (2.27%)2 (3.33%)0.221
90–99%15 (14.42%)4 (9.09%)11 (18.33%)0.185
Occlusion7 (6.73%)1 (2.27%)6 (10.0%)0.031*

Factors predicting clinical severity and long-term risk of major amputation following PTA

VariablesStage IV Leriche-FontaineMajor amputation
OR95% CIp valueHR95% CIp value
Male1.330.52–3.380.5451.340.38–4.700.649
Age1.410.94–2.120.1000.980.61–1.590.928
Ischemic heart disease1.520.68–3.390.3061.310.89–1.930.159
Diabetes mellitus1.450.66–3.170.3512.590.86–7.740.089
Obesity1.540.61–3.870.3610.820.26–2.550.729
Active smoking1.030.47–2.230.9511.750.59–4.960.262
Dyslipidemia1.550.71–3.380.2791.240.46–3.340.672
Leriche-Fontaine III–––0.770.28–2.120.612
Leriche-Fontaine IV–––1.300.47–3.57
SII1.71#1.04–3.460.0551.56#1.11–2.190.010*
SIRI2.28#1.16–4.490.0171.63#1.13–2.360.009*
AISI2.32#1.03–5.260.0431.55#1.08–2.220.016*
DOI: https://doi.org/10.2478/jce-2024-0014 | Journal eISSN: 2457-5518 | Journal ISSN: 2457-550X
Journal RSS Feed
Language: English
Page range: 102 - 110
Submitted on: May 9, 2024
Accepted on: Jun 26, 2024
Published on: Sep 30, 2024
Published by: Asociatia Transilvana de Terapie Transvasculara si Transplant KARDIOMED
In partnership with: Paradigm Publishing Services
Publication frequency: 4 times per year
Keywords:
critical limb ischemia,
percutaneous transluminal angioplasty,
vascular surgery,
inflammatory biomarkers
Related subjects:
Medicine,
Clinical medicine,
Internal medicine,
Cardiology,
Emergency medicine and intensive-care medicine,
Radiology

© 2024 Adrian Vasile Mureșan, Nicolae-Alexandru Lazăr, Reka Bartus, Ludovic-Alexandru Szanto, Bogdan Andrei Cordoș, Bogdan-Corneliu Bandici, Suzana-Vasilica Șincaru, Carina Diana Covalcic, Agatha Maria Ilioniu, Lucian Mărginean, published by Asociatia Transilvana de Terapie Transvasculara si Transplant KARDIOMED
This work is licensed under the Creative Commons Attribution-NonCommercial-NoDerivatives 3.0 License.

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