Long-term prognostic risk score for CLTI including nutritional state

Background Chronic limb-threatening ischemia (CLTI) is well known for its poor prognosis. Although nutritional state is reportedly related to outcome, few studies have considered a long-term prognostic score for CLTI that includes nutritional status. Methods The I-PAD registry was a prospective, multicenter, observational patient registry designed to provide up to 5 years of clinical follow-up data. A total of 366 patients having undergone 463 endovascular treatments for symptomatic lower extremity artery disease were enrolled, from which 125 patients with CLTI were analyzed. We searched for prognostic predictors including nutritional status for amputation-free survival (AFS) to develop a scoring system for long-term CLTI prognosis. Results Median patient age was 77 [68, 86] years and follow-up period was 1729 [797, 1954] days. Cox multivariate analysis revealed Geriatric Nutritional Risk Index score <92 points, >71 years of age, female, heart failure, and anemia (<13.0 g/dL in men and <12.0 g/dL in women) to be significant prognostic predictors for AFS (all p<0.05). We calculated the weighted risk score for each prognostic factor (0 to 11 points) and divided the cohort into the high score group (≥4 points) and low score group (≤3 points). The incidence of AFS at 5 years was significantly lower in the high score group (35.4% vs. 89.5%, p<0.001). The area under the receiver operating characteristic curve was 0.81 for 5-year AFS. Conclusion A higher prognostic score incorporating nutritional state may indicate a worse long-term prognosis in CLTI patients.