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Reversion of the Inflammatory Markers in Patients With Chronic Limb-Threatening Ischemia
Joana Ferreira1,2,3,4,5, Susana Roque2,3, Alexandre Lima Carneiro6
1Vascular Surgery Department-Physiology and Surgery Centro Hospitalar Universitário de São João Porto Portugal.
Insights
Peripheral artery disease patients with chronic limb-threatening ischemia (CLTI) exhibit a distinct inflammatory profile compared to those with claudication. This inflammation can be partially reversed after CLTI resolution, highlighting the need for prompt treatment.
Area of Science:
- Vascular Surgery
- Inflammation Biology
- Clinical Medicine
Background:
- Peripheral artery disease (PAD) involves significant inflammation, correlating with increased mortality, especially in chronic limb-threatening ischemia (CLTI).
- Understanding inflammatory marker evolution in PAD is crucial for patient outcomes.
Purpose of the Study:
- To compare the longitudinal changes in inflammatory markers between patients with claudication and those with CLTI.
- To assess the impact of CLTI resolution on inflammatory markers.
Main Methods:
- An observational, prospective, single-center study included 119 PAD patients (65 claudication, 54 CLTI).
- Inflammatory markers (C-reactive protein, fibrinogen, albumin, total cholesterol, HDL) were measured at baseline and at 3, 6, and 12 months.
- Comparative analysis between claudication and CLTI groups was performed.
Main Results:
- At baseline, CLTI patients showed higher C-reactive protein and fibrinogen, and lower albumin, total cholesterol, and HDL compared to claudication patients.
- The association between CLTI and total cholesterol was not significant after adjusting for confounders.
- Three months post-CLTI resolution, a reversal of inflammatory markers was observed (increased negative acute-phase proteins, decreased positive acute-phase proteins); these changes were not seen in claudication patients and normalized between groups by 6 months.
Conclusions:
- CLTI is associated with a pro-inflammatory state that can be modulated by resolving the ischemic condition.
- Timely intervention for CLTI is critical for potentially reversing associated inflammatory processes.
Background:
Peripheral artery disease is characterized by an intense inflammatory process that can be associated with a higher mortality rate, particularly in chronic limb-threatening ischemia (CLTI). This study aims to compare the evolution of inflammatory markers between patients with claudication with those with CLTI at 3, 6, and 12 months.
Methods And Results:
An observational, single-center, and prospective study was conducted. A total of 119 patients with peripheral artery disease (65 with claudication and 54 with CLTI) were observed and inflammatory markers collected at admission and 3, 6, and 12 months. At admission, patients with CLTI, when compared with patients with claudication, had significantly higher serum levels of C-reactive protein and fibrinogen (positive acute-phase proteins) and lower serum level of albumin, total cholesterol, and high-density lipoprotein (negative acute-phase proteins): C-reactive protein (g/dL), 2.90 (25th-75th percentile, 2.90-4.90) versus 6.80 (25th-75th percentile, 2.90-53.26) (P=0.000); fibrinogen (mg/dL), 293.00 (25th-75th percentile, 269.25-349.00) versus 415.50 (25th-75th percentile, 312.00-615.75) (P=0.000); total cholesterol (mg/dL), 161.79±95% [152.74-170.85] versus 146.42%±95% [135.30-157.53] (P=0.034); high-density lipoprotein (mg/dL), 50.00 (25th-75th percentile, 41.00-60.00) versus 37.00 (25th-75th percentile, 30.00-45.50) (P=0.000); albumin (g/dL): 4.00 (25th-75th percentile, 3.70-4.20) versus 3.60 (25th-75th percentile, 3.10-4.00) (P=0.003). The association between CLTI and total cholesterol was lost after adjusting for confounders. Three months after the resolution of the CLTI, there was an increase in the levels of negative acute-phase proteins and a decrease in positive acute-phase proteins. These inflammatory proteins did not register an evolution in patients with claudication. The differences in the inflammatory proteins between groups disappeared at 6 months.
Conclusions:
CLTI has an inflammatory environment that can be partially reverted after resolution of the ischemic process, emphasizing the importance of timely intervention.
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