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Impact Of Nutrition On Outcomes Of Limb Salvage For Chronic Limb-Threatening Ischemia
Joseph P Hart, Mark G Davies
Ascension Health, Waco, TX
Background: Poor nutrition is often identified among vascular patients and predict poor surgical outcomes. The aim of this study was to analyze the impact of varying degrees of nutrition and immunocompetence on the outcomes of patients undergoing a lower extremity intervention for chronic limb-threatening ischemia (CLTI).
Methods: Between 2018 and 2022, all patients undergoing a primary intervention for CLTI (bypass, BYP or endovascular interventions, EV) were analyzed. Nutritional and immunocompetency status was measured by the prognostic nutritional index (PNI 10 × serum albumin (g/dl) + 0.005 × total lymphocyte count (per mm
3). Patients were stratified as Normal (PNI value > 50), Mild malnutrition (PNI value 50-46), Moderate malnutrition (PNI value 45-40) and Severe malnutrition (PNI value< 40). Amputation-free survival (AFS; survival without major amputation) and freedom from major adverse limb events (MALE; Above ankle amputation of the index limb or major re-intervention (new bypass graft, jump/interposition graft revision) were evaluated.
Results: 1207 patients ( 64% male, age 65±11years, mean±SD) underwent either EV (66%) or BYP (34%). 1&% patients were classified as Normal, 25% as Mild 35% as Moderate, 24% as Severe. Increasing severity of PNI impacts 30-day outcomes and negatively influenced Freedom from MALE and AFS (Table 1)
| | | | |
| Table 1 Outcomes |
| PNI | Normal | Mild | Moderate | Severe |
| Patients (n) | 207 | 298 | 418 | 284 |
| 30-day MACE | 3% | 3% | 10%* | 15% ** |
| 30-day MALE | 4% | 7%* | 11%* | 19%** |
| 30-day Amputation ‡ | 3% | 5%* | 7%* | 11%** |
| Ulcer Healing months | 83% | 71% | 53%* | 40%** |
| Freedom from MALE yrs | 63±5% | 54±4%* | 38±5%** | 23±4%** |
| Amputation free Survival yrs | 59±5% | 45±6%* | 36±5%** | 25±4%** |
| * p<0.05, **p<0.01 compared to normal PNI group‡ excludes planned major amputation |
Conclusions: The majority of patients presenting with CLTI have an increased risk of poor nutrition and decreased immunocompetence based on the PNI. Increasing severity of PNIis associated with poorer short-term and long-term outcomes. Identifying patients with poor nutrition can help stratify the risk of CLTI interventions.
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