Can C-reactive protein to albumin ratio be used as a predictor of amputation development in acute lower extremity ischemia?

Abstract

Aim: Acute lower limb ischemia is a cardiovascular emergency that occurs due to embolic and thrombotic causes. Inflammatory biomarkers obtained from routine blood parameters have been used in the diagnosis and progression of many cardiovascular diseases. In this study, we aimed to reveal the predictive value of C reactive protein to albumin ratio (CAR) in predicting limb loss, which is a significantly morbid result of thromboembolectomy.
Methods: Patients who were admitted to our clinic with acute lower extremity ischemia between March 15, 2015-March 15, 2018 and who underwent thromboembolectomy were included in this retrospective cohort study. The patients in which no extremity amputation was performed after the surgery were included in Group 1 and those in which amputation was performed in the early post-operative period (in-hospital) were included in Group 2. Multivariate logistic regression analysis was utilized to predict parameters supporting amputation in patients with lower extremity thromboembolism.
Results: There were 207 patients in Group 1 and 32 in Group 2. Amputation was performed above the knee in 5 patients (15.6%), below the knee in 23 patients (71.8%) and below the ankle in 4 patients (12.5%) in Group 2. The mean age of patients in Groups 1 and 2 were 58.7 (9.8) years and 68.3 (10.3) years, respectively (P<0.001). In the regression analysis, advanced age (OR: 1.045, CI 95%: 1.004-2.144, P=0.011), CAR (OR: 1.679, CI 95%: 1.224-3.794, P=0.005) and hospital admission time (OR: 1.054, CI 95%: 1.010-1.458, P=0.022) were determined as independent predictors for amputation.
Conclusion: The CAR value obtained from routine blood parameters obtained before the procedure may be a good predictor of amputation risk.

Keywords

• Inflammation
• Amputation
• Embolectomy
• Lower extremity

C-reaktif protein - albümin oranı akut alt ekstremite iskemisinde amputasyon gelişiminin öngörücüsü olarak kullanılabilir mi?

Öz

Amaç: Akut alt ekstremite iskemisi embolik ve trombotik nedenlerden dolayı ortaya çıkan kardiyovasküler acil bir durumdur. Rutin kan parametrelerinden elde edilen inflamatuar biyobelirteçler birçok kardiyovasküler hastalığın tanısında ve progresyonunda kullanılmıştır. Bu çalışmada, tromboembolektominin önemli bir morbid sonucu olan ekstremite kaybının öngörülmesinde C reaktif proteinin albümin oranının (CAR) prediktif değerini ortaya koymayı amaçladık.
Yöntemler: Kliniğimize akut alt ekstremite iskemi durumu olan 15 Mart 2015-15 Mart 2018 tarihleri arasında başvuran ve tromboembolektomi uygulanan hastalar bu retrospektif kohort çalışmasına dahil edildi. Ameliyat sonrası ekstremite amputasyonu yapılmayan hastalar Grup 1, ameliyat sonrası erken dönemde (hasteneiçi) amputasyon yapılan hastalar Grup 2 olarak kaydedildi.
Bulgular: Hastaların 207'si Grup 1'e, 32'si Grup 2'ye dahil edildi. 5 hastada (%15,6) diz üstünde, 23 hastada (%71,8) diz altında ve 4 hastada (%12,5) ayak bileği altında amputasyon yapıldı. Grup 1'deki hastaların ortalama yaşı 58,7 (9,8) iken, Grup 2'deki hastalar 68,3 (10,3) idi (P<0,001). Alt ekstremite tromboembolizmi olan hastalarda amputasyonu destekleyen parametreleri tahmin etmek için çok değişkenli lojistik regresyon analizi kullanıldı. Bu değerlendirmede, ileri yaş (OR: 1,045, CI% 95: 1,004-2,144, P=0,011), CAR (OR: 1,679, CI %95: 1,224-3,794, P=0,005) ve hastaneye başvuru zamanı (OR: 1,054, CI %95: 1,010-1,458, P=0,022) amputasyonu göstermek için bağımsız prediktörler olarak belirlendi.
Sonuç: Sonuç olarak, işlemden önce alınan rutin kan parametrelerinden elde edilen CAR değeri amputasyon riskinin iyi bir prediktörü olabilir.

Anahtar Kelimeler

• Enflamasyon
• Amputasyon
• Embolektomi
• Alt ekstremite

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