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Impact of malnutrition and frailty on mortality and major amputation in patients with CLTI.
- Source :
-
Catheterization and cardiovascular interventions : official journal of the Society for Cardiac Angiography & Interventions [Catheter Cardiovasc Interv] 2022 Mar; Vol. 99 (4), pp. 1300-1309. Date of Electronic Publication: 2022 Feb 03. - Publication Year :
- 2022
-
Abstract
- Objectives: To understand the prevalence of malnutrition and its association with chronic limb-threatening ischemia (CLTI) outcomes; to clarify the differential impact of revascularization methods on outcomes; to assess the ability of the CLTI Frailty Risk Score (CLTI-FRS) to predict adverse events in patients hospitalized with CLTI.<br />Background: Despite advances in the management of CLTI, a majority still undergo major amputation, and a minority heal within 6 months. There is a lack of validated assessment tools for the identification and management of frailty and malnutrition in these patients.<br />Methods: Using the National Inpatient Sample from January 2012 to September 2015, we identified all patients with CLTI using International Classification of Diseases Ninth Edition Clinical Modification codes. The cohort was divided into three groups according to nutritional status. Multivariable regression analysis was used to analyze the interaction between malnutrition and outcomes of interest.<br />Results: Of 1,414,080 CLTI-related hospitalizations, 163,835 (11.6%) were malnourished, 332,855 (23.5%) patients were frail, 917,390 (64.9%) were well-nourished. In-hospital mortality, major amputation, the average length of stay, and hospital costs were highest among malnourished or frail patients and lowest in well-nourished patients (pā<ā0.001). Malnourished and frail patients were observed to have lower rates of mortality with endovascular revascularization as compared to surgical (adjusted odds ratios: 0.675 [0.533-0.854; pā=ā0.001]).<br />Conclusion: Many patients with CLTI are malnourished or frail, and this is associated with mortality and amputation. Both malnourished and frail patients were observed to have a mortality benefit with a less invasive approach to revascularization. Better assessment of nutritional and frailty status of CLTI patients may guide therapy and help prevent amputation and death.<br /> (© 2022 Wiley Periodicals LLC.)
- Subjects :
- Amputation, Surgical
Chronic Disease
Chronic Limb-Threatening Ischemia
Humans
Ischemia diagnosis
Ischemia surgery
Limb Salvage
Risk Factors
Time Factors
Treatment Outcome
Endovascular Procedures adverse effects
Frailty
Malnutrition diagnosis
Malnutrition etiology
Malnutrition surgery
Peripheral Arterial Disease diagnosis
Peripheral Arterial Disease surgery
Subjects
Details
- Language :
- English
- ISSN :
- 1522-726X
- Volume :
- 99
- Issue :
- 4
- Database :
- MEDLINE
- Journal :
- Catheterization and cardiovascular interventions : official journal of the Society for Cardiac Angiography & Interventions
- Publication Type :
- Academic Journal
- Accession number :
- 35114067
- Full Text :
- https://doi.org/10.1002/ccd.30113