Risk stratification for low extremity amputation in critical limb ischemia patients who have undergone endovascular revascularization: A survival tree analysis
Journal
Medicine (United States)
Journal Volume
98
Journal Issue
33
Date Issued
2019
Author(s)
Abstract
Patients with peripheral artery disease (PAD) are a heterogeneous population and differ in risk of mortality and low extremity amputation (LEA), which complicates clinical decision-making. This study aimed to develop a simple risk scale using decision tree methodology to guide physicians in managing critical limb ischemia (CLI) patients who will benefit from endovascular therapy (EVT).A total of 736 patients with CLI, Rutherford classification (RC) stage ?4, and prior successful EVT were included. Variables significantly associated with LEA by univariate analysis (P < .05) were selected and put into classification tree analysis using the Classification and Regression Tree (CART) model with a dependent variable, amputation, and depth of tree = 3. Four risk groups were generated according to the order of amputation rate. The amputation-free survival (AFS) times between groups were compared using the Kaplan-Meier curve with the log-rank test.Patients were classified as high risk for amputation (G4) (WBC counts ?10,000/μl, and platelet-lymphocyte ratio (PLR) ?130.337); intermediate risk group 1 (G3) (WBC < 10,000/μl and RC stage before EVT > 5); intermediate risk group 2 (G2) (WBC count ? 10,000/μl, and PLR < 130.337) and low-risk group (G1) (WBC < 10,000/μl, RC before EVT ? 5). G2, G3, and G4 risk groups had shorter AFS time (range, 58.7 to 65.5 months) than the G1 risk group (100 months) (P < .05). Risk of LEA was significantly higher in the G4, G3, and G2 groups than in the G1 group (P ? .05). The G4 group had the highest risk of amputation (odds ratio = 6.84, P < .001).This simple risk scale model can help healthcare professionals more easily identify and appropriately treat patients with CLI who are at different levels of risk for LEA following endovascular revascularization. ? 2019 the Author(s).
Subjects
amputation; critical limb ischemia; endovascular therapy; risk stratification
SDGs
Other Subjects
albumin; creatinine; hemoglobin A1c; high density lipoprotein cholesterol; aged; albumin blood level; amputation free survival; Article; chronic kidney failure; coronary artery disease; critical limb ischemia; decision tree; end stage renal disease; endovascular surgery; estimated glomerular filtration rate; female; hematocrit; high density lipoprotein cholesterol level; high risk population; human; iliac artery; intermediate risk population; leg amputation; leg revascularization; low risk population; lymphocyte count; major clinical study; male; neutrophil count; neutrophil lymphocyte ratio; observational study; platelet count; platelet lymphocyte ratio; priority journal; prospective study; risk factor; amputation; endovascular surgery; ischemia; Kaplan Meier method; lower limb; middle aged; mortality; odds ratio; peripheral occlusive artery disease; postoperative complication; proportional hazards model; retrospective study; risk factor; treatment outcome; vascularization; Aged; Amputation; Endovascular Procedures; Female; Humans; Ischemia; Kaplan-Meier Estimate; Lower Extremity; Male; Middle Aged; Odds Ratio; Peripheral Arterial Disease; Postoperative Complications; Proportional Hazards Models; Retrospective Studies; Risk Factors; Treatment Outcome
Publisher
Lippincott Williams and Wilkins
Type
journal article