Annals of vascular surgery · 2026
Beyond Anatomy: Integrating Host Reserve Biomarkers with Society for Vascular Surgery Wound, Ischemia, and Foot Infection to Predict Major Amputation in Chronic Limb-Threatening Ischemia - A Retrospective Study From a Tertiary Center in South India.
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Paul Aisel, Subhalal Arunlal, J B Sreelakshmi, O S Sooraj
Аннотация
BACKGROUND: Chronic limb-threatening ischemia (CLTI) carries a high risk of major amputation. Although the Society for Vascular Surgery (SVS) Wound, Ischemia, and Foot Infection (WIfI) classification provides validated anatomical risk stratification, substantial heterogeneity persists within advanced stages. We evaluated whether integrating systemic physiological biomarkers and Doppler-based ischemia grading appears to improve prediction of major amputation.
METHODS: In this retrospective cohort study, 66 diabetic patients with CLTI (January 2024-January 2026) were analyzed. Baseline SVS WIfI stage, arterial Doppler waveform-based ischemia grade, and admission biomarkers (serum albumin, hemoglobin (Hb), and neutrophil-lymphocyte ratio [NLR]) were recorded. The primary endpoint was major amputation or in-hospital mortality. Predictive performance of an anatomical-only model was compared with a composite model incorporating host reserve biomarkers using multivariable logistic regression and receiver operating characteristic (ROC) analysis.
RESULTS: Major amputation occurred in 31 patients (47.0%). WIfI stage strongly predicted outcome (P < 0.001), with 76.3% of stage 4 patients requiring amputation. Doppler-based ischemia grade showed a significant graded association with limb loss (P < 0.001). Patients undergoing major amputation had lower serum albumin (1.94 vs. 2.45 g/dL; P < 0.001), lower Hb (9.15 vs. 10.48 g/dL; P = 0.005), and higher NLR (9.12 vs. 5.46; P = 0.003). Model discrimination improved from area under the ROC curve 0.846 to 0.907 (DeLong test, P = 0.015) with biomarker integration.
CONCLUSION: While SVS WIfI staging remains an important anatomical predictor, the addition of Doppler waveform morphology and systemic physiological markers appears to improve risk stratification, supporting a dual-axis framework integrating anatomical severity and host resilience in CLTI; however, these findings should be considered exploratory and require validation in larger prospective cohorts.
METHODS: In this retrospective cohort study, 66 diabetic patients with CLTI (January 2024-January 2026) were analyzed. Baseline SVS WIfI stage, arterial Doppler waveform-based ischemia grade, and admission biomarkers (serum albumin, hemoglobin (Hb), and neutrophil-lymphocyte ratio [NLR]) were recorded. The primary endpoint was major amputation or in-hospital mortality. Predictive performance of an anatomical-only model was compared with a composite model incorporating host reserve biomarkers using multivariable logistic regression and receiver operating characteristic (ROC) analysis.
RESULTS: Major amputation occurred in 31 patients (47.0%). WIfI stage strongly predicted outcome (P < 0.001), with 76.3% of stage 4 patients requiring amputation. Doppler-based ischemia grade showed a significant graded association with limb loss (P < 0.001). Patients undergoing major amputation had lower serum albumin (1.94 vs. 2.45 g/dL; P < 0.001), lower Hb (9.15 vs. 10.48 g/dL; P = 0.005), and higher NLR (9.12 vs. 5.46; P = 0.003). Model discrimination improved from area under the ROC curve 0.846 to 0.907 (DeLong test, P = 0.015) with biomarker integration.
CONCLUSION: While SVS WIfI staging remains an important anatomical predictor, the addition of Doppler waveform morphology and systemic physiological markers appears to improve risk stratification, supporting a dual-axis framework integrating anatomical severity and host resilience in CLTI; however, these findings should be considered exploratory and require validation in larger prospective cohorts.
Предметные рубрики MeSH
HumansRetrospective StudiesAmputation, SurgicalFemaleMalePredictive Value of TestsRisk FactorsIschemiaBiomarkersTertiary Care CentersIndiaAgedRisk AssessmentDecision Support TechniquesSerum Albumin, HumanMiddle AgedDiabetic FootPeripheral Arterial DiseaseUltrasonography, DopplerChronic DiseaseTreatment OutcomeSeverity of Illness IndexHospital MortalityTime FactorsHemoglobinsNeutrophilsLimb Salvage