Pronóstico global de los pacientes con isquemia crítica de las extremidades inferiores

Abstract

ObjetiveTo study the factors that affect the vital and overall functional prognosis of patients with lower limb critical ischaemia (LLCI), including any diseased sector and treatment methods. Material and methodsA prospective cohort study was conducted on patients with LLCI. A record was made of their demographic data, cardiovascular risk factors, comorbidity, blood test parameters, Mini Nutritional Assessment (MNA) questionnaire, treatment, and outcome. An analysis was made on the mortality, limb salvage, and freedom from re-admission (FRR) rates, as well as the impact of the described parameters on these outcome variables, using Kaplan-Meier curves and Cox regression. ResultsA total of 133 patients were included, 103 (77.4%) men, with a mean age of 74.8 years (SD 10.4; range 52-93). There was tissue loss in 97 (72.9%) cases. A total of 87 (65.4%) patients were revascularised, 48 using open techniques and 39 endovascular. A primary major amputation was performed on 5 (3.8%) patients, and 41 (30.8%) were treated conservatively, with or without minor amputation. Survival rates were 85% and 81% at 6 and 12 months, respectively, with limb salvage rates of 84% and 82% and FRR of 52% and 31%, respectively, for the same time periods. Hypoalbuminaemia increased the risk of death (P=.024) and a low score in the MNA questionnaire was associated with increased risk of limb loss (P=.021). More re-admissions were observed among patients revascularised with endovascular techniques (P=.001) and those with initial tissue loss (P=.001). ConclusionsMalnutrition is a very prevalent and potentially treatable factor, which has great impact on the vital and functional prognosis of patients with lower limb critical ischaemia.