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Nomogram for predicting amputation-free survival in acute lower limb ischemia patients treated by endovascular
1Department of Interventional Radiology, Nanjing First Hospital, Nanjing Medical University, Nanjing, China.
Insights
This study developed a nomogram to predict amputation-free survival (AFS) in acute lower limb ischemia (ALLI) patients after endovascular therapy. The tool accurately identifies patients at risk, aiding in treatment decisions.
Area of Science:
- Vascular Surgery
- Medical Imaging & Diagnostics
- Biostatistics
Background:
- Acute lower limb ischemia (ALLI) poses a significant risk of amputation.
- Endovascular therapy is a common treatment for ALLI, but predicting outcomes remains challenging.
- Accurate prediction of amputation-free survival (AFS) is crucial for patient management.
Purpose of the Study:
- To develop and validate a novel nomogram for predicting AFS in ALLI patients treated with endovascular therapy.
- To identify independent risk factors associated with amputation in this patient cohort.
Main Methods:
- A retrospective analysis of 415 Chinese patients with ALLI who underwent endovascular therapy.
- Patients were divided into training (n=311) and validation (n=104) cohorts.
- Univariate and multivariate analyses identified independent risk factors for AFS, upon which a nomogram was constructed and validated.
Main Results:
- Advanced age, smoking history, atrial fibrillation, and insufficient outflow were identified as independent negative predictors of AFS.
- The developed nomogram demonstrated high predictive accuracy, with AUROC values of 0.912 in the training cohort and 0.889 in the validation cohort.
Conclusions:
- The study successfully developed an accurate nomogram to predict AFS in ALLI patients undergoing endovascular therapy.
- The nomogram incorporates key risk factors, offering a valuable tool for clinical decision-making and patient risk stratification.
Objectives:
To develop a novel and accurate nomogram to predict survival without amputation in patients with acute lower limb ischemia (ALLI) during the first year following endovascular therapy.
Methods:
Patients with ALLI who underwent endovascular therapy in our department between January 2012 and September 2020 were screened and included in the research. The included patients were randomly divided into a training and validation cohorts, respectively. Univariate and multivariate analyses were used in the training cohort to identify independent risk factors for amputation-free survival (AFS). A nomogram was then developed according to the identified independent risk factors. The nomogram was then validated in the validation cohort.
Results:
415 Chinese patients with 417 affected limbs were included in this study. Among these patients, 311 patients were classified into the training cohort and 104 patients were assigned to the validation cohort. Most patients were men (n = 240) and the average age of patients was 71.43 (standard deviation 8.86) years old. After the univariate and multivariate analyses, advanced age (p < 0.001), history of smoking (p < 0.001), atrial fibrillation (p < 0.001), and insufficient outflow (p = 0.001) were revealed as independent risk factors for AFS during the first year. The nomogram yielded AUROC values of 0.912 (95 % confidence interval [CI]: 0.873-0.950) and 0.889 (95 % CI: 0.812-0.967) in the training and validation cohorts, respectively.
Conclusion:
Advanced age, history of smoking, atrial fibrillation, and insufficient outflow were independent negative predictors for AFS in ALLI patients treated by endovascular therapy. The novel nomogram offered an accurate prediction of AFS in ALLI patients.
