RT info:eu-repo/semantics/doctoralThesis
T1 El impacto del estado nutricional e inflamatorio en los pacientes con isquemia crítica de miembros inferiores
A1 García Rivera, Elena
A2 Universidad de Valladolid. Escuela de Doctorado
K1 Isquemia
K1 Ischemia
K1 Enfermedad arterial periférica
K1 Nutrition assessment
K1 Biomarcadores
K1 Mortality
K1 Albúmina sérica
K1 32 Ciencias Médicas
AB BACKGROUNDPeripheral arterial disease (PAD) is a disease with a high prevalence and is an independent risk factor for mortality. It is a chronic inflammatory disease and a proinflammatory state enhances its development and progression. Moreover, malnutrition has been shown to be an independent factor of poor prognosis, increasing postoperative complications and mortality. Since inflammatory and nutritional status are closely related, nutritional and inflammatory biomarkers such as the neutrophil/lymphocyte ratio (NLR), platelet/lymphocyte ratio (PLR) and lymphocyte/monocyte ratio (LMR), the CONUT (Controlling Nutritional Status) index and the Prognostic Nutritional Index (PNI) have been described and could be very useful in predicting the prognosis of patients with critical ischemia.OBJECTIVEThe primary endpoint was to establish the correlation between different pre-operative biomarkers with short and medium-term mortality and morbidity (6 and 12 months) in patients with critical limb-threatening ischaemia (CTLI) undergoing revascularisation.METHODSRetrospective observational cohort study on a prospective database that included all consecutive patients diagnosed with a first episode of CLTI revascularized from January 2016 to December 2020. Laboratory and demographic data were collected within the first 48 hours of admission. Postsurgical complications, major amputations and mortality at 6 and 12 months were recorded according to risk groups defined by preoperative biomarkers.RESULTSA total of 340 patients were included. Patients with high CONUT (p=0.000), NLR (p=0.000) and PLR (p=0.004) values, as well as low PNI values (p=0.000) had lower survival in the first six months. No significant differences were found for LMR (p=0.060). Regarding mid-term mortality, patients with high NLR (p=0.000), PLR (p=0.003) and CONUT (p=0.000) values, as well as low PNI (p=0.000) and LMR (p=0.000) values had lower survival.A CONUT index above 4.00 was the only independent biomarker that was related to both short and medium-term mortality (p=0.003 and p=0.001, respectively). A high CONUT value was also an independent marker equivalent to other risk factors such as hypertension, age or chronic kidney disease.Regarding short-term major amputations, only patients with high NLR and low PNI valued had lower amputation-free rates (p=0.000 and p=0.005, respectively), with no differences observed with other biomarkers. Regarding mid-term amputations, patients with high NLR (p=0.000), PLR (p=0.004) and CONUT (p=0.001), as well as low PNI (p=0.004) values had a shorter amputation-free rates with no differences in LMR.The only independent marker that was related with short and medium-term major amputations was a PNI below 44.45 (p=0.047 and p=0.035). However, when the PNI was compared to other risk factors, it was not a comparable biomarker to other risk factors such as reinterventions or DM.CONCLUSIONSPreoperative biomarkers based on nutritional and inflammatory parameters are very useful in predicting short and medium-term mortality. Also, the CONUT index is an independent marker of mortality equivalent to other risk factors. For major amputations, PNI could be a useful predictor biomarker.Due to the close relationship of nutritional status with inflammation and its role in the prognosis of CLTI, a simple blood test can be used to obtain preoperative index that identify vulnerable patients with a higher risk of postoperative morbidity and mortality.
YR 2024
FD 2024
LK https://uvadoc.uva.es/handle/10324/71475
UL https://uvadoc.uva.es/handle/10324/71475
LA spa
NO Escuela de Doctorado
DS UVaDOC
RD 22-nov-2024