{"title":"Editor's Choice – Prognostic Factors and Models to Predict Mortality Outcomes in Patients with Peripheral Arterial Disease: A Systematic Review","authors":"","doi":"10.1016/j.ejvs.2024.05.029","DOIUrl":null,"url":null,"abstract":"<div><h3>Objective</h3><p>Predicting adverse outcomes in patients with peripheral arterial disease (PAD) is a complex task owing to the heterogeneity in patient and disease characteristics. This systematic review aimed to identify prognostic factors and prognostic models to predict mortality outcomes in patients with PAD Fontaine stage I – III or Rutherford category 0 – 4.</p></div><div><h3>Data Sources</h3><p>PubMed, Embase, and Cochrane Database of Systematic Reviews were searched to identify studies examining individual prognostic factors or studies aiming to develop or validate a prognostic model for mortality outcomes in patients with PAD.</p></div><div><h3>Review Methods</h3><p>Information on study design, patient population, prognostic factors, and prognostic model characteristics was extracted, and risk of bias was evaluated.</p></div><div><h3>Results</h3><p>Sixty nine studies investigated prognostic factors for mortality outcomes in PAD. Over 80 single prognostic factors were identified, with age as a predictor of death in most of the studies. Other common factors included sex, diabetes, and smoking status. Six studies had low risk of bias in all domains, and the remainder had an unclear or high risk of bias in at least one domain. Eight studies developed or validated a prognostic model. All models included age in their primary model, but not sex. All studies had similar discrimination levels of > 70%. Five of the studies on prognostic models had an overall high risk of bias, whereas two studies had an overall unclear risk of bias.</p></div><div><h3>Conclusion</h3><p>This systematic review shows that a large number of prognostic studies have been published, with heterogeneity in patient populations, outcomes, and risk of bias. Factors such as sex, age, diabetes, hypertension, and smoking are significant in predicting mortality risk among patients with PAD Fontaine stage I – III or Rutherford category 0 – 4.</p></div>","PeriodicalId":55160,"journal":{"name":"European Journal of Vascular and Endovascular Surgery","volume":null,"pages":null},"PeriodicalIF":5.7000,"publicationDate":"2024-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S1078588424004568/pdfft?md5=ff0520c0a4927696b999de13502de93b&pid=1-s2.0-S1078588424004568-main.pdf","citationCount":"0","resultStr":null,"platform":"Semanticscholar","paperid":null,"PeriodicalName":"European Journal of Vascular and Endovascular Surgery","FirstCategoryId":"3","ListUrlMain":"https://www.sciencedirect.com/science/article/pii/S1078588424004568","RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q1","JCRName":"PERIPHERAL VASCULAR DISEASE","Score":null,"Total":0}
引用次数: 0
Abstract
Objective
Predicting adverse outcomes in patients with peripheral arterial disease (PAD) is a complex task owing to the heterogeneity in patient and disease characteristics. This systematic review aimed to identify prognostic factors and prognostic models to predict mortality outcomes in patients with PAD Fontaine stage I – III or Rutherford category 0 – 4.
Data Sources
PubMed, Embase, and Cochrane Database of Systematic Reviews were searched to identify studies examining individual prognostic factors or studies aiming to develop or validate a prognostic model for mortality outcomes in patients with PAD.
Review Methods
Information on study design, patient population, prognostic factors, and prognostic model characteristics was extracted, and risk of bias was evaluated.
Results
Sixty nine studies investigated prognostic factors for mortality outcomes in PAD. Over 80 single prognostic factors were identified, with age as a predictor of death in most of the studies. Other common factors included sex, diabetes, and smoking status. Six studies had low risk of bias in all domains, and the remainder had an unclear or high risk of bias in at least one domain. Eight studies developed or validated a prognostic model. All models included age in their primary model, but not sex. All studies had similar discrimination levels of > 70%. Five of the studies on prognostic models had an overall high risk of bias, whereas two studies had an overall unclear risk of bias.
Conclusion
This systematic review shows that a large number of prognostic studies have been published, with heterogeneity in patient populations, outcomes, and risk of bias. Factors such as sex, age, diabetes, hypertension, and smoking are significant in predicting mortality risk among patients with PAD Fontaine stage I – III or Rutherford category 0 – 4.
目的由于患者和疾病特征的异质性,预测外周动脉疾病(PAD)患者的不良预后是一项复杂的任务。本系统综述旨在确定预测 PAD 方丹分期 I - III 或卢瑟福分级 0 - 4 患者死亡结局的预后因素和预后模型。数据来源检索了 PubMed、Embase 和 Cochrane 系统综述数据库,以确定检查单个预后因素的研究或旨在开发或验证 PAD 患者死亡结局预后模型的研究。综述方法提取了有关研究设计、患者人群、预后因素和预后模型特征的信息,并对偏倚风险进行了评估。结果有 69 项研究调查了 PAD 死亡率预后因素。在大多数研究中,年龄是预测死亡的一个因素。其他常见因素包括性别、糖尿病和吸烟状况。六项研究在所有方面的偏倚风险都较低,其余研究至少在一个方面的偏倚风险不明确或较高。八项研究开发或验证了一种预后模型。所有模型的主要模型都包括年龄,但不包括性别。所有研究的分辨水平相似,均为 70%。结论本系统综述显示,已发表的大量预后研究在患者人群、结果和偏倚风险方面存在异质性。性别、年龄、糖尿病、高血压和吸烟等因素对预测 PAD 方丹 I - III 期或卢瑟福 0 - 4 类患者的死亡风险具有重要意义。
期刊介绍:
The European Journal of Vascular and Endovascular Surgery is aimed primarily at vascular surgeons dealing with patients with arterial, venous and lymphatic diseases. Contributions are included on the diagnosis, investigation and management of these vascular disorders. Papers that consider the technical aspects of vascular surgery are encouraged, and the journal includes invited state-of-the-art articles.
Reflecting the increasing importance of endovascular techniques in the management of vascular diseases and the value of closer collaboration between the vascular surgeon and the vascular radiologist, the journal has now extended its scope to encompass the growing number of contributions from this exciting field. Articles describing endovascular method and their critical evaluation are included, as well as reports on the emerging technology associated with this field.