Risk prediction model for early outcomes of revascularization for chronic limb-threatening ischaemia.
Aged
Aged, 80 and over
Chronic Limb-Threatening Ischemia
/ surgery
Databases, Factual
Endovascular Procedures
/ methods
Female
Follow-Up Studies
Humans
Incidence
Japan
/ epidemiology
Leg
/ blood supply
Male
Postoperative Complications
/ epidemiology
Retrospective Studies
Risk Assessment
/ methods
Risk Factors
Time Factors
Journal
The British journal of surgery
ISSN: 1365-2168
Titre abrégé: Br J Surg
Pays: England
ID NLM: 0372553
Informations de publication
Date de publication:
19 08 2021
19 08 2021
Historique:
received:
01
10
2020
revised:
15
11
2020
accepted:
17
01
2021
pubmed:
12
3
2021
medline:
17
12
2021
entrez:
11
3
2021
Statut:
ppublish
Résumé
Quantifying the risks and benefits of revascularization for chronic limb-threatening ischaemia (CLTI) is important. The aim of this study was to create a risk prediction model for treatment outcomes 30 days after revascularization in patients with CLTI. Consecutive patients with CLTI who had undergone revascularization between 2013 and 2016 were collected from the JAPAN Critical Limb Ischemia Database (JCLIMB). The cohort was divided into a development and a validation cohort. In the development cohort, multivariable risk models were constructed to predict major amputation and/or death and major adverse limb events using least absolute shrinkage and selection operator logistic regression. This developed model was applied to the validation cohort and its performance was evaluated using c-statistic and calibration plots. Some 2906 patients were included in the analysis. The major amputation and/or mortality rate within 30 days of arterial reconstruction was 5.0 per cent (144 of 2906), and strong predictors were abnormal white blood cell count, emergency procedure, congestive heart failure, body temperature of 38°C or above, and hemodialysis. Conversely, moderate, low or no risk in the Geriatric Nutritional Risk Index (GNRI) and ambulatory status were associated with improved results. The c-statistic value was 0.82 with high prediction accuracy. The rate of major adverse limb events was 6.4 per cent (185 of 2906), and strong predictors were abnormal white blood cell count and body temperature of 38°C or above. Moderate, low or no risk in the GNRI, and age greater than 84 years were associated with improved results. The c-statistic value was 0.79, with high prediction accuracy. This risk prediction model can help in deciding on the treatment strategy in patients with CLTI and serve as an index for evaluating the quality of each medical facility.
Sections du résumé
BACKGROUND
Quantifying the risks and benefits of revascularization for chronic limb-threatening ischaemia (CLTI) is important. The aim of this study was to create a risk prediction model for treatment outcomes 30 days after revascularization in patients with CLTI.
METHODS
Consecutive patients with CLTI who had undergone revascularization between 2013 and 2016 were collected from the JAPAN Critical Limb Ischemia Database (JCLIMB). The cohort was divided into a development and a validation cohort. In the development cohort, multivariable risk models were constructed to predict major amputation and/or death and major adverse limb events using least absolute shrinkage and selection operator logistic regression. This developed model was applied to the validation cohort and its performance was evaluated using c-statistic and calibration plots.
RESULTS
Some 2906 patients were included in the analysis. The major amputation and/or mortality rate within 30 days of arterial reconstruction was 5.0 per cent (144 of 2906), and strong predictors were abnormal white blood cell count, emergency procedure, congestive heart failure, body temperature of 38°C or above, and hemodialysis. Conversely, moderate, low or no risk in the Geriatric Nutritional Risk Index (GNRI) and ambulatory status were associated with improved results. The c-statistic value was 0.82 with high prediction accuracy. The rate of major adverse limb events was 6.4 per cent (185 of 2906), and strong predictors were abnormal white blood cell count and body temperature of 38°C or above. Moderate, low or no risk in the GNRI, and age greater than 84 years were associated with improved results. The c-statistic value was 0.79, with high prediction accuracy.
CONCLUSION
This risk prediction model can help in deciding on the treatment strategy in patients with CLTI and serve as an index for evaluating the quality of each medical facility.
Identifiants
pubmed: 33693591
pii: 6161218
doi: 10.1093/bjs/znab036
doi:
Types de publication
Journal Article
Multicenter Study
Research Support, Non-U.S. Gov't
Langues
eng
Sous-ensembles de citation
IM
Pagination
941-950Investigateurs
K Shigematsu
(K)
N Azuma
(N)
A Ishida
(A)
Y Izumi
(Y)
Y Inoue
(Y)
H Uchida
(H)
T Ohki
(T)
S Kuma
(S)
K Kurosawa
(K)
A Kodama
(A)
H Komai
(H)
K Komori
(K)
T Shibuya
(T)
S Shindo
(S)
I Sugimoto
(I)
J Deguchi
(J)
K Hoshina
(K)
H Maeda
(H)
H Midorikawa
(H)
T Yamaoka
(T)
H Yamashita
(H)
Y Yunoki
(Y)
Commentaires et corrections
Type : ErratumIn
Informations de copyright
© The Author(s) 2021. Published by Oxford University Press on behalf of BJS Society Ltd. All rights reserved. For permissions, please email: journals.permissions@oup.com.