Factors Affecting Mortality After Major Nontraumatic Lower Extremity Amputation.

Area of Science:

• Vascular Surgery
• Diabetic Complications
• Inflammatory Markers

Background:

• Nontraumatic lower limb amputations are often necessitated by ischemic or diabetic complications.
• Identifying factors influencing patient mortality post-amputation is crucial for improving outcomes.
• Previous studies have explored various risk factors, but specific predictors in this patient cohort require further elucidation.

Purpose of the Study:

• To evaluate factors affecting mortality in patients undergoing major lower limb amputation due to ischemic and/or diabetic causes.
• To identify independent risk factors for mortality in this specific patient population.

Main Methods:

• A retrospective study included 100 patients undergoing lower limb amputation for ischemic or diabetic reasons.
• Data collected included amputation level (below-knee vs. above-knee) and neutrophil lymphocyte ratio (NLR).
• Multivariable Poisson regression analysis was employed to identify independent risk factors for mortality.

Main Results:

• Mortality rates were higher in patients undergoing above-knee amputation (40%) compared to below-knee amputation (15.7%).
• Female gender (Risk Ratio [RR] = 2.00) and a neutrophil lymphocyte ratio (NLR) less than 6.8 (RR = 5.12) were identified as independent risk factors for mortality.
• The NLR cutoff of 6.8 demonstrated good predictive value (Area Under Curve = 0.73).

Conclusions:

• Female gender and a low NLR (<6.8) are significant independent predictors of increased mortality in patients undergoing lower limb amputation for ischemic or diabetic conditions.
• While amputation level and congestive heart failure were associated with mortality in univariable analysis, they did not remain significant in multivariable analysis.
• These findings highlight the importance of considering gender and inflammatory markers in risk stratification for patients undergoing lower limb amputation.