Naples Score: A Novel Predictor of Infrapopliteal Artery Disease Severity and Complexity

Peripheral artery disease (PAD), particularly infrapopliteal lesions, represents a severe form of atherosclerotic vascular disease. The Naples prognostic score (NPS), which reflects systemic inflammation and nutritional status, has emerged as a potential predictor of cardiovascular outcomes. This study investigates the association between the NPS and the severity of infrapopliteal artery disease, as classified by the Trans-Atlantic Inter-Society Consensus II (TASC II) system.

We retrospectively analyzed data from 282 patients with infrapopliteal lesions who underwent peripheral angiography. Patients were grouped by TASC II classification (A-B versus C-D). The NPS was calculated using serum albumin, total cholesterol, neutrophil-to-lymphocyte ratio, and lymphocyte-to-monocyte ratio. Statistical analysis included receiver operating characteristic (ROC) curve and logistic regression.

NPS values were significantly higher in patients with TASC C-D lesions than those with TASC A-B lesions (2.5 ± 0.92 vs. 1.49 ± 0.98, P < 0.001). ROC analysis showed the NPS had the highest predictive value for disease severity (area under the curve: 0.77). Multivariate analysis identified NPS as an independent predictor of complex lesion presence.

The NPS is a robust and independent marker for predicting the severity and complexity of infrapopliteal PAD. Its ease of calculation and cost-effectiveness make it a valuable tool for clinical risk stratification.