[Clinical and laboratory predictors of amputation in patients with acute limb ischemia].

OBJECTIVE

The purpose of the study was to determine clinical and laboratory predictors suggesting an unfavorable outcome of acute limb ischemia.

PATIENTS AND

METHODS

The work was based on retrospective assessment of treatment of 556 patients with confirmed acute limb ischemia, undergoing treatment in 2000-2018. All patients were operated on. The mean age amounted to 69.9±12.8 years. Women accounted for 51.3%. According to the classification of I.I. Zatevakhin, degree I ischemia was in 36.1% of patients, degree II in 59.2%, and degree III in 4.7%. In the majority of patients, acute ischemia was caused by arterial embolism. The patients were divided into two groups: Group 1 included those discharged with the saved limb after restoration of arterial blood flow and Group 2 comprised patients discharged after amputation.

RESULTS

The time from the onset of the disease to the moment of surgical intervention in Group 2 was 10.3-fold longer (p=0.0001). Arterial thrombosis was 2.5 times more associated with the risk of major amputation (p=0.002). The chance of amputation in acute ischemia of upper extremities was 6.8 times less than in lesions of lower limbs (p=0.003). Distal lesions of lower-limb arteries increased 3.6-fold the risk of amputation (p=0.001). The chance of limb loss directly depended on the ischemia degree (p<0.024). In Group 2 patients, the neutrophil-to-lymphocyte ratio was 1.5-fold higher (p=0.001).

CONCLUSION

The duration prior to revascularization, limb ischemia degree, etiology and the level of the arterial bed lesion remain the most significant predictors of an unfavorable outcome in acute limb ischemia. Elevated values of the neutrophil-to-lymphocyte ratio appeared to directly associated with the necessity to perform amputation.