PMID- 34541783
OWN - NLM
STAT- MEDLINE
DCOM- 20220202
LR  - 20221207
IS  - 1522-726X (Electronic)
IS  - 1522-1946 (Linking)
VI  - 99
IP  - 1
DP  - 2022 Jan 1
TI  - The utility of geriatric nutritional risk index to predict outcomes in chronic 
      limb-threatening ischemia.
PG  - 121-133
LID - 10.1002/ccd.29949 [doi]
AB  - OBJECTIVES: To assess geriatric nutritional risk index (GNRI) in patients with 
      chronic limb-threatening ischemia (CLTI). BACKGROUND: The prevalence of CLTI 
      continues to rise, with major amputation and mortality remaining prominent. 
      Frailty is a vital risk factor for adverse outcomes in cardiovascular care. The 
      GNRI is a nutrition-based surrogate for frailty that has been utilized in 
      Southeast Asia to predict adverse events in CLTI. It has not yet been evaluated 
      in a primarily Western population, nor in the context of wound healing. METHODS: 
      Between 8August 2017 and April 2019, we identified patients undergoing 
      endovascular interventions for CLTI at our institution, categorized into low GNRI 
      (</= 94, frail) versus normal GNRI (> 94, reference). We analyzed the risks of 
      major adverse limb events (MALE), its individual components [mortality, major 
      amputation, and target vessel revascularization (TVR)], amputation free survival 
      (AFS), and wound healing using Kaplan-Meier and multivariate cox-proportional 
      hazard regression analyses. RESULTS: A total of 255 patients were included in the 
      analysis, with follow up of 14 +/- 9.1 months. Lower GNRI was associated with 
      higher cumulative event rates for MALE (71.0% vs. 43.3%, p <  0.001), mortality 
      (34.3% vs. 15.2%, p < 0.001), major amputation (31.2% vs. 15.8%, p = 0.002), and 
      freedom from AFS (56.0% vs. 28.2%, p < 0.001). There was a trend toward lower TVR 
      and higher wound healing with higher GNRI score. CONCLUSIONS: Our single-center, 
      retrospective evaluation of GNRI (as a surrogate for frailty) correlated with 
      increased risks of MALE, mortality, and major amputation. Future directions 
      should focus not only on the recognition of these patients, but risk-factor 
      modification to optimize long-term outcomes.
CI  - (c) 2021 Wiley Periodicals LLC.
FAU - Li, Jun
AU  - Li J
AUID- ORCID: 0000-0002-2064-4992
AD  - Harrington Heart and Vascular Institute, University Hospitals Cleveland Medical 
      Center, Cleveland, Ohio, USA.
FAU - Arora, Shilpkumar
AU  - Arora S
AD  - Harrington Heart and Vascular Institute, University Hospitals Cleveland Medical 
      Center, Cleveland, Ohio, USA.
FAU - Ikeoka, Kuniyasu
AU  - Ikeoka K
AD  - Harrington Heart and Vascular Institute, University Hospitals Cleveland Medical 
      Center, Cleveland, Ohio, USA.
FAU - Smith, Justin
AU  - Smith J
AD  - Harrington Heart and Vascular Institute, University Hospitals Cleveland Medical 
      Center, Cleveland, Ohio, USA.
FAU - Dash, Siddhartha
AU  - Dash S
AUID- ORCID: 0000-0001-8870-8422
AD  - School of Medicine, Case Western Reserve University, Cleveland, Ohio, USA.
FAU - Kimura, Stephen
AU  - Kimura S
AD  - School of Medicine, Case Western Reserve University, Cleveland, Ohio, USA.
FAU - Mously, Haytham
AU  - Mously H
AD  - Harrington Heart and Vascular Institute, University Hospitals Cleveland Medical 
      Center, Cleveland, Ohio, USA.
FAU - Hammad, Tarek A
AU  - Hammad TA
AD  - Harrington Heart and Vascular Institute, University Hospitals Cleveland Medical 
      Center, Cleveland, Ohio, USA.
FAU - Kashyap, Vikram
AU  - Kashyap V
AD  - Harrington Heart and Vascular Institute, University Hospitals Cleveland Medical 
      Center, Cleveland, Ohio, USA.
FAU - Shishehbor, Mehdi H
AU  - Shishehbor MH
AD  - Harrington Heart and Vascular Institute, University Hospitals Cleveland Medical 
      Center, Cleveland, Ohio, USA.
LA  - eng
PT  - Journal Article
DEP - 20210919
PL  - United States
TA  - Catheter Cardiovasc Interv
JT  - Catheterization and cardiovascular interventions : official journal of the 
      Society for Cardiac Angiography & Interventions
JID - 100884139
SB  - IM
MH  - Aged
MH  - Amputation, Surgical
MH  - Chronic Disease
MH  - *Chronic Limb-Threatening Ischemia
MH  - Humans
MH  - Ischemia/diagnosis/surgery
MH  - Limb Salvage
MH  - *Peripheral Arterial Disease/diagnostic imaging/therapy
MH  - Retrospective Studies
MH  - Risk Factors
MH  - Treatment Outcome
OTO - NOTNLM
OT  - chronic limb-threatening ischemia (CLTI)
OT  - frailty
OT  - geriatric nutritional risk index (GNRI)
OT  - outcomes
EDAT- 2021/09/21 06:00
MHDA- 2022/02/03 06:00
CRDT- 2021/09/20 06:37
PHST- 2021/07/28 00:00 [revised]
PHST- 2021/04/21 00:00 [received]
PHST- 2021/09/01 00:00 [accepted]
PHST- 2021/09/21 06:00 [pubmed]
PHST- 2022/02/03 06:00 [medline]
PHST- 2021/09/20 06:37 [entrez]
AID - 10.1002/ccd.29949 [doi]
PST - ppublish
SO  - Catheter Cardiovasc Interv. 2022 Jan 1;99(1):121-133. doi: 10.1002/ccd.29949. 
      Epub 2021 Sep 19.