[MO-70] Presentation Awards
Further risk stratification by systemic factors in WIfI (Wound, Ischemia, and foot Infection classification system) Stage 4 but not in Stage 1-3 in chronic limb-threatening ischemia
Background: The latest guidelines emphasize the importance of assessing limb characteristics, including the Wound, Ischemia, and foot Infection (WIfI) classification for predicting limb prognosis in critical limb-threatening ischemia (CTLI). On the other hand, previous reports suggested that some systemic factors were associated with the limb prognosis.
Objectives: The aim of this study was to reveal the prognostic impact of patient characteristics on limb prognosis in CTLI undergoing endovascular therapy (EVT).
Methods: We analyzed 735 CTLI patients (age 73.9±9.8 years, male 61.2%, diabetes 66.8％, hemodialysis 54.1％) who underwent the initial EVT between April 2010 and December 2015. The limb severity at baseline was assessed by the WIfI classification. The predictors of wound healing in WIfI stage 1-3 and 4 were explored by Cox proportional hazards regression analysis.
Results: The 1-year wound healing rate was 60% in WIfI stage 1-3 and 54% in WIfI stage 4 patients, respectively (P=0.011). In WIfI stage 1-3, no systemic factors were significantly associated with delayed wound healing, whereas in WIfI stage 4, the following three factors were identified as independent risk factors for delayed wound healing: (1) non-ambulatory status (hazard ratio (HR) 0.49 [95% confidential interval (CI) 0.34-0.71], P<0.001), (2) hemodialysis (HR 0.56 [0.38-0.83], P=0.004) and (3) hypoalbuminemia under 3.0 g/dl (HR 0.63 [0.42-0.96], P=0.032). In figure, the 1-year wound healing rate in WIfI stage 4 with ≤1 of the three risk factors was 68%, which was significantly higher than that in WIfI stage 4 with ≥2 risk factor (36%, p<0.001), and comparable to that in WIfI stage 1-3 (60%, p> 0.05).
Conclusions: Non-ambulatory status, hemodialysis and hypoalbuminemia were additional risk factors for delayed wound healing in WIfI stage 4. Freedom from accumulation of these risk factors in WIfI stage 4 was comparable in wound healing to WIfI stage 1-3.
Objectives: The aim of this study was to reveal the prognostic impact of patient characteristics on limb prognosis in CTLI undergoing endovascular therapy (EVT).
Methods: We analyzed 735 CTLI patients (age 73.9±9.8 years, male 61.2%, diabetes 66.8％, hemodialysis 54.1％) who underwent the initial EVT between April 2010 and December 2015. The limb severity at baseline was assessed by the WIfI classification. The predictors of wound healing in WIfI stage 1-3 and 4 were explored by Cox proportional hazards regression analysis.
Results: The 1-year wound healing rate was 60% in WIfI stage 1-3 and 54% in WIfI stage 4 patients, respectively (P=0.011). In WIfI stage 1-3, no systemic factors were significantly associated with delayed wound healing, whereas in WIfI stage 4, the following three factors were identified as independent risk factors for delayed wound healing: (1) non-ambulatory status (hazard ratio (HR) 0.49 [95% confidential interval (CI) 0.34-0.71], P<0.001), (2) hemodialysis (HR 0.56 [0.38-0.83], P=0.004) and (3) hypoalbuminemia under 3.0 g/dl (HR 0.63 [0.42-0.96], P=0.032). In figure, the 1-year wound healing rate in WIfI stage 4 with ≤1 of the three risk factors was 68%, which was significantly higher than that in WIfI stage 4 with ≥2 risk factor (36%, p<0.001), and comparable to that in WIfI stage 1-3 (60%, p> 0.05).
Conclusions: Non-ambulatory status, hemodialysis and hypoalbuminemia were additional risk factors for delayed wound healing in WIfI stage 4. Freedom from accumulation of these risk factors in WIfI stage 4 was comparable in wound healing to WIfI stage 1-3.