Nobuyoshi Azuma1, Mitsuyoshi Takahara2, Akio Kodama3, Yoshimitsu Soga4, Hiroto Terashi5, Junichi Tazaki6, Terutoshi Yamaoka7, Atsuhiro Koya1, Osamu Iida8. 1. Department of Vascular Surgery, Asahikawa Medical University, Japan (N.A., A.K.). 2. Department of Diabetes Care Medicine, and Department of Metabolic Medicine, Osaka University Graduate School of Medicine, Suita, Japan (M.T.). 3. Division of Vascular Surgery, Department of Surgery, Nagoya University School of Medicine, Japan (A.K.). 4. Department of Cardiology, Kokura Memorial Hospital, Kitakyushu, Japan (Y.S.). 5. Department of Plastic Surgery, Kobe University Graduate School of Medicine, Japan (H.T.). 6. Department of Cardiovascular Medicine, Graduate School of Medicine, Kyoto University, Japan (J.T.). 7. Department of Vascular Surgery, Matsuyama Red Cross Hospital, Japan (T.Y). 8. Cardiovascular Center, Kansai Rosai Hospital, Amagasaki, Japan (O.I.).
Abstract
BACKGROUND: The aim of this study was to develop a predictive model for mortality risk based on preoperative risk factors, including the Wound, Ischemia, Foot Infection (WIfI) classification, in patients undergoing revascularization for critical limb ischemia. METHODS: We analyzed a database of the Surgical reconstruction versus Peripheral Intervention in Patients With Critical Limb Ischemia registry, a multicenter, prospective, observational study that included 520 critical limb ischemia patients (192 surgical and 328 endovascular patients). RESULTS: Multivariate Cox regression analysis identified old age, impaired mobility, low body mass index, renal failure, heart failure, and high WIfI grade as independent risk factors for all-cause mortality (all P<0.05). The risk score comprising these risk factors discriminated the mortality risk well; the 2-year survival rate was >90% in the first quantile of the risk score and ≈20% in the fifth quantile. The area under the time-dependent receiver operating characteristics curve was 0.829 for thirty-day mortality and 0.811 for 2-year mortality. Adding more detailed preoperative information to the predictive model revealed that cystatin C-based estimated glomerular filtration rate, left ventricular ejection fraction, and cholinesterase levels were additional independent risk factors, but the predictive accuracy of the model was not significantly improved, according to the time-dependent receiver operating characteristics curve and net reclassification improvement. CONCLUSIONS: The current study developed a risk score for mortality using preoperative risk factors, including the WIfI classification, in critical limb ischemia patients undergoing revascularization.
BACKGROUND: The aim of this study was to develop a predictive model for mortality risk based on preoperative risk factors, including the Wound, Ischemia, Foot Infection (WIfI) classification, in patients undergoing revascularization for critical limb ischemia. METHODS: We analyzed a database of the Surgical reconstruction versus Peripheral Intervention in Patients With Critical Limb Ischemia registry, a multicenter, prospective, observational study that included 520 critical limb ischemiapatients (192 surgical and 328 endovascular patients). RESULTS: Multivariate Cox regression analysis identified old age, impaired mobility, low body mass index, renal failure, heart failure, and high WIfI grade as independent risk factors for all-cause mortality (all P<0.05). The risk score comprising these risk factors discriminated the mortality risk well; the 2-year survival rate was >90% in the first quantile of the risk score and ≈20% in the fifth quantile. The area under the time-dependent receiver operating characteristics curve was 0.829 for thirty-day mortality and 0.811 for 2-year mortality. Adding more detailed preoperative information to the predictive model revealed that cystatin C-based estimated glomerular filtration rate, left ventricular ejection fraction, and cholinesterase levels were additional independent risk factors, but the predictive accuracy of the model was not significantly improved, according to the time-dependent receiver operating characteristics curve and net reclassification improvement. CONCLUSIONS: The current study developed a risk score for mortality using preoperative risk factors, including the WIfI classification, in critical limb ischemiapatients undergoing revascularization.
Entities:
Keywords:
ambulation difficulty; body mass index; foot ulcer; heart failure; kidney failure; peripheral arterial disease; survival analysis