The impact of malnutrition-inflammation-atherosclerosis (MIA) syndrome on the prognosis of elderly patients with chronic limb-threatening ischemia after endovascular therapy

Abstract

Abstract Background Chronic limb-threatening ischemia (CLTI) is known to the most advanced form of severe arteriosclerosis in peripheral artery disease and cause poor prognosis. Whereas malnutrition (M), inflammation (I) and atherosclerosis (A) are reported to be involved in the pathophysiology of end-stage renal disease with close relevancy and affect its clinical outcomes, the effect of such MIA syndrome on the mortality in elderly patients with CLTI has not been well evaluated. Purpose The aim of the present study was to investigate the influence of patient characteristics including MIA syndrome on the mortality in elderly CLTI patients <3 years after endovascular therapy (EVT). Methods The subject was 222 consecutive elderly (≥65 year) CLTI patients who were admitted to undergo endovascular therapy (EVT). We assessed nutritional status using Geriatric Nutritional Risk Index (GNRI) in this study, and defined patients with GNRI <92 at admission as malnutrition. We also assessed inflammatory status using hs-CRP. The patients were divided into four groups based on their nutrition and inflammatory status as follows; Group A; GNRI <92+hs-CRP ≥1 mg/dL, Group B; GNRI <92+hs-CRP <1 mg/dL, Group C; GNRI >92+hs-CRP ≥1 mg/dL, Group D; GNRI >92+hs-CRP <1 mg/dL. Patients in the group A were considered to be under MIA syndrome. We evaluated which Group affected prognosis of elderly CLTI patients after endovascular therapy (EVT). Results All-cause death after EVT were 37 cases (17%). In this study, all patients underwent successful EVT for target lesions. As a result of cox proportional hazards analysis, all-cause death was associated with MIA syndrome [hazard ratio (HR): 2.41, 95% confidence interval (CI): 1.13–5.17, p<0.001)], Clinical Fraility Scale (HR: 1.46, 95% CI: 1.127–1.93, p=0.005), and history of stroke (HR: 2.32, 95% CI: 1.11–4.86, p=0.026) in the univariate analysis. Multivariate cox proportional hazards analysis models after adjusted for the demographic characteristics of patients and clinically relevant factors for all-cause death after EVT revealed that MIA syndrome and history of stroke were independent risk factors (HR: 3.94, 95% CI: 1.34–11.63, p=0.013, HR: 3.06, 95% CI: 1.14–8.18, p=0.026,). Kaplan Meier analysis also elucidated that survival rate was significantly lower in Group A compared to those in other Groups (p=0.0131). Furthermore, cox proportional hazards models using each Group A to D revealed that only Group A was associated with all-cause death (Group A: HR 2.41, 95% CI: 1.13–5.17, p=0.024, Group B: HR 1.01, 95% CI: 0.41–2.46, p=0.976, Group C: HR 1.01, 95% CI: 0.35–2.88, p=0.987, Group D: HR 0.57, 95% CI: 0.30–1.13, p=0.109). Conclusions MIA syndrome was a strong predictor for incidence of all-cause death in elderly CLTI patients after EVT. Funding Acknowledgement Type of funding sources: None.