Edoardo Pasqui, Giulia Casilli, Tommaso Anichini, Eleonora Cerbini, Giuseppe Galzerano, Gianmarco de Donato
{"title":"将 \"合并症-多药性评分 \"作为慢性肢体缺血下肢血管重建术患者存活率和肢体挽救率的预测工具。","authors":"Edoardo Pasqui, Giulia Casilli, Tommaso Anichini, Eleonora Cerbini, Giuseppe Galzerano, Gianmarco de Donato","doi":"10.1016/j.avsg.2024.09.061","DOIUrl":null,"url":null,"abstract":"<p><strong>Background: </strong>The comorbidity-polypharmacy score (CPPS) was created to evaluate the clinical burden of comorbidities in geriatric patients. It represents an objective tool to stratify patients' risk in different settings. The study aimed to evaluate CPPS in predicting mortality and amputation in patients undergoing elective revascularization procedures in chronic limb-threatening ischemia (CLTI) patients.</p><p><strong>Methods: </strong>This is a 2-year retrospective single-center study. We included all patients undergoing elective lower-limb revascularization procedures admitted with CLTI diagnosis. Four CPPS groups were defined: mild, moderate, severe, and morbid. The primary early and long-term outcomes were 30-day overall mortality, 30-day amputation rate, and overall survival and limb salvage, respectively.</p><p><strong>Results: </strong>A total of 442 patients were enrolled in the study. Mean age was 76.5 ± 9.9 years, and 61.5% (272/442) were male. CPPS was calculated: 22.6% (100/442) have mild CPPS, 54.3% (240/442) moderate, 21.9% (97/442) severe, and 1.2% (5/442) morbid. Kaplan-Meier curves for overall survival stratified by CPPS grade highlighted a strong statistically significant difference (P < 0.0001) among the 4 CPPS classes. Mild CPPS has a significantly higher limb salvage rate among moderate, severe, and morbid CPPS groups (P < 0.0001). Limb salvage for mild and severe CPPS, at 36 months was 95% vs. 85.1%, respectively. Stepwise multivariable Cox-analysis revealed that mortality was independently associated with dialysis, Rutherford Classification V, age, and CPPS. Male sex, multilevel arterial disease, and hybrid surgical repair were independently associated with amputations.</p><p><strong>Conclusions: </strong>CPPS is a straightforward tool to evaluate the patient's complexity and could be used as an adjuvant tool to stratify early- and long-term outcomes in CLTI patients undergoing elective revascularization procedures.</p>","PeriodicalId":1,"journal":{"name":"Accounts of Chemical Research","volume":null,"pages":null},"PeriodicalIF":16.4000,"publicationDate":"2024-10-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":"{\"title\":\"The Comorbidity-Polypharmacy Score as a Predictive Tool of Survival and Limb Salvage in Patients Undergoing Lower Limb Revascularization Procedures for Chronic Limb-Threatening Ischemia.\",\"authors\":\"Edoardo Pasqui, Giulia Casilli, Tommaso Anichini, Eleonora Cerbini, Giuseppe Galzerano, Gianmarco de Donato\",\"doi\":\"10.1016/j.avsg.2024.09.061\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<p><strong>Background: </strong>The comorbidity-polypharmacy score (CPPS) was created to evaluate the clinical burden of comorbidities in geriatric patients. It represents an objective tool to stratify patients' risk in different settings. The study aimed to evaluate CPPS in predicting mortality and amputation in patients undergoing elective revascularization procedures in chronic limb-threatening ischemia (CLTI) patients.</p><p><strong>Methods: </strong>This is a 2-year retrospective single-center study. We included all patients undergoing elective lower-limb revascularization procedures admitted with CLTI diagnosis. Four CPPS groups were defined: mild, moderate, severe, and morbid. The primary early and long-term outcomes were 30-day overall mortality, 30-day amputation rate, and overall survival and limb salvage, respectively.</p><p><strong>Results: </strong>A total of 442 patients were enrolled in the study. Mean age was 76.5 ± 9.9 years, and 61.5% (272/442) were male. CPPS was calculated: 22.6% (100/442) have mild CPPS, 54.3% (240/442) moderate, 21.9% (97/442) severe, and 1.2% (5/442) morbid. Kaplan-Meier curves for overall survival stratified by CPPS grade highlighted a strong statistically significant difference (P < 0.0001) among the 4 CPPS classes. Mild CPPS has a significantly higher limb salvage rate among moderate, severe, and morbid CPPS groups (P < 0.0001). Limb salvage for mild and severe CPPS, at 36 months was 95% vs. 85.1%, respectively. Stepwise multivariable Cox-analysis revealed that mortality was independently associated with dialysis, Rutherford Classification V, age, and CPPS. Male sex, multilevel arterial disease, and hybrid surgical repair were independently associated with amputations.</p><p><strong>Conclusions: </strong>CPPS is a straightforward tool to evaluate the patient's complexity and could be used as an adjuvant tool to stratify early- and long-term outcomes in CLTI patients undergoing elective revascularization procedures.</p>\",\"PeriodicalId\":1,\"journal\":{\"name\":\"Accounts of Chemical Research\",\"volume\":null,\"pages\":null},\"PeriodicalIF\":16.4000,\"publicationDate\":\"2024-10-18\",\"publicationTypes\":\"Journal Article\",\"fieldsOfStudy\":null,\"isOpenAccess\":false,\"openAccessPdf\":\"\",\"citationCount\":\"0\",\"resultStr\":null,\"platform\":\"Semanticscholar\",\"paperid\":null,\"PeriodicalName\":\"Accounts of Chemical Research\",\"FirstCategoryId\":\"3\",\"ListUrlMain\":\"https://doi.org/10.1016/j.avsg.2024.09.061\",\"RegionNum\":1,\"RegionCategory\":\"化学\",\"ArticlePicture\":[],\"TitleCN\":null,\"AbstractTextCN\":null,\"PMCID\":null,\"EPubDate\":\"\",\"PubModel\":\"\",\"JCR\":\"Q1\",\"JCRName\":\"CHEMISTRY, MULTIDISCIPLINARY\",\"Score\":null,\"Total\":0}","platform":"Semanticscholar","paperid":null,"PeriodicalName":"Accounts of Chemical Research","FirstCategoryId":"3","ListUrlMain":"https://doi.org/10.1016/j.avsg.2024.09.061","RegionNum":1,"RegionCategory":"化学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q1","JCRName":"CHEMISTRY, MULTIDISCIPLINARY","Score":null,"Total":0}
The Comorbidity-Polypharmacy Score as a Predictive Tool of Survival and Limb Salvage in Patients Undergoing Lower Limb Revascularization Procedures for Chronic Limb-Threatening Ischemia.
Background: The comorbidity-polypharmacy score (CPPS) was created to evaluate the clinical burden of comorbidities in geriatric patients. It represents an objective tool to stratify patients' risk in different settings. The study aimed to evaluate CPPS in predicting mortality and amputation in patients undergoing elective revascularization procedures in chronic limb-threatening ischemia (CLTI) patients.
Methods: This is a 2-year retrospective single-center study. We included all patients undergoing elective lower-limb revascularization procedures admitted with CLTI diagnosis. Four CPPS groups were defined: mild, moderate, severe, and morbid. The primary early and long-term outcomes were 30-day overall mortality, 30-day amputation rate, and overall survival and limb salvage, respectively.
Results: A total of 442 patients were enrolled in the study. Mean age was 76.5 ± 9.9 years, and 61.5% (272/442) were male. CPPS was calculated: 22.6% (100/442) have mild CPPS, 54.3% (240/442) moderate, 21.9% (97/442) severe, and 1.2% (5/442) morbid. Kaplan-Meier curves for overall survival stratified by CPPS grade highlighted a strong statistically significant difference (P < 0.0001) among the 4 CPPS classes. Mild CPPS has a significantly higher limb salvage rate among moderate, severe, and morbid CPPS groups (P < 0.0001). Limb salvage for mild and severe CPPS, at 36 months was 95% vs. 85.1%, respectively. Stepwise multivariable Cox-analysis revealed that mortality was independently associated with dialysis, Rutherford Classification V, age, and CPPS. Male sex, multilevel arterial disease, and hybrid surgical repair were independently associated with amputations.
Conclusions: CPPS is a straightforward tool to evaluate the patient's complexity and could be used as an adjuvant tool to stratify early- and long-term outcomes in CLTI patients undergoing elective revascularization procedures.
期刊介绍：
Accounts of Chemical Research presents short, concise and critical articles offering easy-to-read overviews of basic research and applications in all areas of chemistry and biochemistry. These short reviews focus on research from the author’s own laboratory and are designed to teach the reader about a research project. In addition, Accounts of Chemical Research publishes commentaries that give an informed opinion on a current research problem. Special Issues online are devoted to a single topic of unusual activity and significance.
Accounts of Chemical Research replaces the traditional article abstract with an article "Conspectus." These entries synopsize the research affording the reader a closer look at the content and significance of an article. Through this provision of a more detailed description of the article contents, the Conspectus enhances the article's discoverability by search engines and the exposure for the research.
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