Annals of vascular surgery · 2025
Relationship of the Wound, Ischemia, and Foot Infection Stage with Frailty, Disability, Quality of Life, and One-Year Outcomes in All-Comers with Chronic Limb-Threatening Ischemia: Single-Center Prospective Cohort Study.
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Houghton John S M, Black Imelda, Meffen Anna, Gray Laura J, Payne Tanya J, Haunton Victoria J, Rayt Harjeet S, Sayers Rob D, Leg Ischaemia Management collaboration
Аннотация
BACKGROUND: The wound, ischemia and foot infection (WIfI) classification system has been widely adopted in chronic limb-threatening ischemia (CLTI) management. Primary aim was to prospectively investigate the association of WIfI stage with 1-year major amputation. Secondary aims included investigating associations of WIfI stage with baseline frailty, disability, and quality of life (QoL).
METHODS: Single-center prospective cohort study (NCT04027244). CLTI patients presenting between May 2019 and March 2022 were eligible. Frailty (clinical frailty scale), disability (Barthel index), and QoL (vascular QoL questionnaire; EQ-5D-5L) assessments were performed at baseline. Major amputation incidence for each WIfI stage was presented as percentages with 95% confidence intervals (CIs). Association of WIfI stage with 1-year major amputation was investigated using Fine-Gray competing risk analysis (death as competing risk), reported as subdistribution hazard ratios (SHRs) with 95% CI.
RESULTS: A total of 363 patients were included. Increasing WIfI stage was associated with increasing frailty prevalence and frailty severity (P = 0.002), and greater disability (P < 0.001). QoL scores were similar for each WIfI stage. Major amputation incidence at 1-year was 2% (95% CI, 0%-11%) for WIfI stage 1, 7% (95% CI, 4%-14%) stage 2, 8% (95% CI, 4%-15%) stage 3, and 20% (95% CI, 13%-30%) for stage 4. Increasing WIfI stage was independently associated with 1-year major amputation (SHR, 1.99; 95% CI, 1.33-2.97; P = 0.001).
CONCLUSION: WIfI clinical stage is strongly associated with major amputation at 1-year in patients with CLTI. Given its lack of association with QoL, WIfI stages may not reflect the full severity of symptoms experienced by patients.
METHODS: Single-center prospective cohort study (NCT04027244). CLTI patients presenting between May 2019 and March 2022 were eligible. Frailty (clinical frailty scale), disability (Barthel index), and QoL (vascular QoL questionnaire; EQ-5D-5L) assessments were performed at baseline. Major amputation incidence for each WIfI stage was presented as percentages with 95% confidence intervals (CIs). Association of WIfI stage with 1-year major amputation was investigated using Fine-Gray competing risk analysis (death as competing risk), reported as subdistribution hazard ratios (SHRs) with 95% CI.
RESULTS: A total of 363 patients were included. Increasing WIfI stage was associated with increasing frailty prevalence and frailty severity (P = 0.002), and greater disability (P < 0.001). QoL scores were similar for each WIfI stage. Major amputation incidence at 1-year was 2% (95% CI, 0%-11%) for WIfI stage 1, 7% (95% CI, 4%-14%) stage 2, 8% (95% CI, 4%-15%) stage 3, and 20% (95% CI, 13%-30%) for stage 4. Increasing WIfI stage was independently associated with 1-year major amputation (SHR, 1.99; 95% CI, 1.33-2.97; P = 0.001).
CONCLUSION: WIfI clinical stage is strongly associated with major amputation at 1-year in patients with CLTI. Given its lack of association with QoL, WIfI stages may not reflect the full severity of symptoms experienced by patients.