Elevated Composite Inflammatory Markers are Associated with Clinical Severity and Long-term Amputation Risk in Patients with Critical Limb Ischemia after Percutaneous Transluminal Angioplasty

Abstract Background Chronic limb-threatening ischemia (CLTI) represents the advanced stages of peripheral arterial disease (PAD) and is caused by atherosclerotic damage in the lower limbs, having a greater risk of major amputation. Aim The aim of this study was to analyze the impact of systemic immune index (SII), systemic inflammation response index (SIRI), and the aggregate index of systemic inflammation (AISI) on the clinical severity and long-term risk of amputation among patients with CLTI after percutaneous transluminal angioplasty (PTA). Material and Methods This is a retrospective observational study involving 104 patients diagnosed with CLTI and treated with PTA. Based on clinical severity, the cohort was divided into two groups: stage III Leriche-Fontaine and stage IV Leriche-Fontaine. Results We observed higher levels of SII (p = 0.027), SIRI (p = 0.0008), and AISI (p = 0.0024) in patients with trophic lesions. Kaplan–Meier analysis showed that patients with values of SII (p = 0.008), SIRI (p = 0.022), and AISI (p = 0.006) above the median at the time of admission are at a higher risk of major amputation in the long term following PTA. At the multivariate regression analysis, high baseline values of SIRI (odds ratio (OR) = 2.28; p = 0.017) and AISI (OR = 2.32; p = 0.043) were associated with stage IV Leriche-Fontaine, but not SII (OR = 1.71; p = 0.055). Additionally, in the Cox regression analysis, we found that SII (hazard ratio (HR) = 1.56; p = 0.010), SIRI (HR = 1.63; p = 0.009), and AISI (HR = 1.55; p = 0.016) are predictive factors for long-term risk of major amputation after endovascular treatment. Conclusions Elevated levels of SIRI and AISI have been found to be linked with the severity of clinical symptoms and an increased risk of long-term major amputation in patients with CLTI following PTA. Additionally, higher baseline values for SII were associated with a greater risk of major amputation, but not with clinical severity in the same group of patients.