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Published on: September 22, 2020
Predictive value of the inflammatory indices on wound healing in patients with chronic limb-threatening ischemia
Yeliz Guler1, Omer Genc1, Furkan Akbas2
1Department of Cardiology, Basaksehir Cam & Sakura City Hospital, University of Health Sciences, Istanbul, Turkey.
Introduction:
Peripheral artery disease (PAD) is a common manifestation of atherosclerosis. Despite the effectiveness of endovascular therapy (EVT), patients with PAD often face poor prognoses. This study investigates the relationship between specific inflammatory indices and wound healing in patients with Fontaine stage 4 chronic limb-threatening ischemia (CLTI).
Methods:
From June 2021 to January 2024, 168 patients with Fontaine stage 4 CLTI, totaling 185 affected extremities, who underwent successful EVT, were assessed retrospectively. Patients were categorized based on wound healing post-EVT. The Naples prognostic score (NPS), pan-immune inflammation value (PIV), systemic immune-inflammation index (SII), and systemic inflammation response index (SIRI) were calculated. Discrimination and decision curve analyses were used to explore the link between inflammation and wound healing.
Results:
Wound healing was observed in 142 (76.8%) patients post-EVT. Nonhealing patients exhibited higher indices of NPS, PIV, SII, and SIRI. NPS (aOR = 0.381, 95% CI 0.215-0.675, p = 0.001), PIV (aOR = 0.997, 95% CI 0.996-0.999, p < 0.001), SII (aOR = 0.997, 95% CI 0.996-0.997, p < 0.001), and SIRI (aOR = 0.443, 95% CI 0.313-0.625, p < 0.001) were independently predictive of wound healing. SIRI (AUC = 0.840, 95% CI 0.777-0.904) demonstrated superior predictive ability compared to PIV (AUC = 0.799, 95% CI 0.722-0.876, pdif < 0.001), SII (AUC = 0.788, 95% CI 0.712-0.865, pdif < 0.001), and NPS (AUC = 0.760, 95% CI 0.681-0.838, pdif < 0.001). SIRI also showed higher net reclassification improvement over PIV (68.4%, pdif < 0.001), SII (38.5%, pdif = 0.024), and NPS (29.8%, pdif = 0.079). All inflammatory indices, especially SIRI, provided prognostic value in determining wound healing at high treatment thresholds (> 40%).
Conclusion:
In patients with CLTI undergoing EVT, SIRI, SII, PIV, and NPS may help predict the potential for wound healing during in-hospital follow up, with SIRI being the strongest predictor.
