ABSTRACTObjectives To validate the WIfI classification in a Brazilian population; to evaluate the association of the WIfI classification with major amputation, mortality and amputation-free survival; to identify factors associated with major amputation, mortality and amputation free-survival; and to evaluate the accuracy of WIfI classification in predicting major amputation. Methods A retrospective cohort study in a public university hospital in Belo Horizonte, Brazil, evaluating patients with chronic limb threatening ischemia and or diabetic foot, between 2015 and 2017. All patients were classified using the WIfI classification system and categorized into the 4 stages of risk of amputation very low (1), low (2), moderate (3) and high (4). Analyzed variables included demographics, risk factors and comorbidities, length of stay, mobility, nutritional risk, major amputation, mortality and amputation free-survival. Statistical analysis included Chi-square, Kaplan-Meier, and ROC curve analyses. Results A total of 660 patients were enrolled (mean age 65.5 years, 62.9% male). Worse mobility at admission was associated with higher amputation risk stages. Women had higher rates of nutritional risk and more severe limb ischemia. Patients in stage 4 had the longest hospital stays. Revascularization was performed in 41.2% of patients. The one-year amputation, mortality, and amputation-free survival rates were 26.5%, 15.0%, and 64.5%, respectively. There was a linear correlation between risk stages and outcomes, with the highest amputation risk stages (3–4) having the highest amputation and mortality rates and the lowest amputation-free survival. Women had higher amputation and mortality rates. Multivariable analysis showed that nutritional risk increased the likelihood of major amputation by 81%, while revascularization reduced it by 48%. Kaplan-Meier analysis showed amputation-free survival rates of 85.7% in Stage 1 and 47.0% in Stage 4 at one year. Stage 4 reliably predicted major amputation with a sensitivity of 60.6% and a specificity of 74.4%. Conclusions The SVS-WIfI classification system is valid for the Brazilian population, showing a linear correlation between risk stages and rates of amputation, mortality, and amputation-free survival. Patients at Stage 4, with nutritional risk, impaired mobility, and female sex had worse outcomes. Revascularization procedures were associated with reduced amputation and mortality and increased amputation-free survival, with Stage 4 accurately predicting major amputation. This study identifies nutritional risk and impaired mobility as novel independent predictors of amputation and death in CLTI, supporting the integration of nutritional and functional assessments into multidisciplinary protocols to enhance limb salvage.
Luz et al. (Fri,) studied this question.