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Published on: September 22, 2020
Sarcopenia is a risk factor for major adverse cardiac events after surgical revascularization for critical limb
Nehir Selçuk1, Şebnem Albeyoğlu1, Murat Bastopcu1
1Department of Cardiovascular Surgery, 111319Dr Siyami Ersek Thoracic and Cardiovascular Surgery Research and Training Center, Uskudar Turkey.
Insights
Sarcopenia significantly increases major adverse cardiac events (MACE) after critical limb ischemia (CLI) surgery, but not major adverse limb events (MALE). Platelet-to-lymphocyte ratio (PLR) shows limited value in identifying sarcopenia in these patients.
Area of Science:
- Vascular Surgery
- Geriatrics
- Cardiology
Background:
- Critical limb ischemia (CLI) is a severe condition requiring surgical revascularization.
- Sarcopenia, age-related muscle loss, may impact surgical outcomes.
- Inflammatory markers like neutrophil-to-lymphocyte ratio (NLR) and platelet-to-lymphocyte ratio (PLR) are explored as potential indicators.
Purpose of the Study:
- To investigate the effect of sarcopenia on early surgical outcomes (MACE, MALE) in CLI patients.
- To evaluate NLR and PLR as indicators of sarcopenia in CLI patients undergoing revascularization.
Main Methods:
- Observational retrospective single-center study of 217 CLI patients undergoing revascularization.
- Sarcopenia defined by psoas muscle index (PMI) from CT scans.
- Analysis of 30-day MACE and MALE; comparison of NLR and PLR between sarcopenic and non-sarcopenic groups.
Main Results:
- 37.8% of patients were sarcopenic; sarcopenic patients were older and had a higher history of myocardial infarction.
- Sarcopenia was associated with significantly increased 30-day MACE (9.8% vs 0.7%, p=0.002) but not MALE.
- PLR was higher in sarcopenic patients (127.16 vs 104.06, p=0.010), but with low sensitivity (53.7%) and specificity (68.1%) for detecting sarcopenia.
Conclusions:
- Sarcopenia is linked to increased perioperative mortality and MACE in CLI patients post-revascularization.
- Sarcopenia does not significantly increase early MALE in this cohort.
- PLR has limited utility as a simple diagnostic marker for sarcopenia in CLI patients due to poor accuracy.
Objectives:
We examined the effect of sarcopenia on early surgical outcomes in patients with critical limb ischemia (CLI) in terms of major adverse cardiac events (MACE) and major adverse limb events (MALE), as well as the value of inflammatory markers of neutrophil-to-lymphocyte (NLR) and platelet-to-lymphocyte ratios (PLR) as indicators of sarcopenia in CLI patients.
Methods:
This was an observational retrospective single-center study. Patients who required surgical revascularization for CLI between October 2015 and December 2020 were identified. Psoas muscle areas were calculated from computed tomography images for psoas muscle index (PMI) calculations. Sarcopenia was defined as PMI < 5.5 cm2/m2 for men and PMI < 4.0 cm2/m2 for women. Risk factors for 30-day major adverse cardiac events (MACE) and major adverse limb events (MALE) were analyzed. NLR and PLR were compared between sarcopenic and non-sarcopenic patients.
Results:
The mean age of 217 study patients was 61.5 ± 10.9, and 16 (7.4%) patients were female. 82 (37.8%) patients were sarcopenic. Patients with sarcopenia were older (65.1 ± 9.3 vs 59.4 ± 11.2, p < .001) and history of myocardial infarction was more frequent (23.2% vs 12.6%, p = 0.042) among sarcopenic patients. Sarcopenic patients more frequently encountered MACE (9.8% vs 0.7%, p = 0.002), but not MALE. Sarcopenia increased early postoperative MACE in our cohort with an odds ratio of 11.925. NLR was not different between the two groups, while PLR was higher (127.16 vs 104.06, p = 0.010) among sarcopenic patients. The platelet-to-lymphocyte ratio of 125.11 had a sensitivity of 53.7% and a specificity of 68.1% for differentiating sarcopenia.
Conclusions:
Sarcopenia was associated with more frequent 30-day MACE and perioperative mortality after revascularization for CLI. 30-day MALE was not increased in patients with sarcopenia. The use of PLR as a simple marker of sarcopenia is limited by its low sensitivity and specificity.
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