PMID- 35114067
OWN - NLM
STAT- MEDLINE
DCOM- 20220421
LR  - 20221207
IS  - 1522-726X (Electronic)
IS  - 1522-1946 (Linking)
VI  - 99
IP  - 4
DP  - 2022 Mar
TI  - Impact of malnutrition and frailty on mortality and major amputation in patients 
      with CLTI.
PG  - 1300-1309
LID - 10.1002/ccd.30113 [doi]
AB  - OBJECTIVES: To understand the prevalence of malnutrition and its association with 
      chronic limb-threatening ischemia (CLTI) outcomes; to clarify the differential 
      impact of revascularization methods on outcomes; to assess the ability of the 
      CLTI Frailty Risk Score (CLTI-FRS) to predict adverse events in patients 
      hospitalized with CLTI. BACKGROUND: Despite advances in the management of CLTI, a 
      majority still undergo major amputation, and a minority heal within 6 months. 
      There is a lack of validated assessment tools for the identification and 
      management of frailty and malnutrition in these patients. METHODS: Using the 
      National Inpatient Sample from January 2012 to September 2015, we identified all 
      patients with CLTI using International Classification of Diseases Ninth Edition 
      Clinical Modification codes. The cohort was divided into three groups according 
      to nutritional status. Multivariable regression analysis was used to analyze the 
      interaction between malnutrition and outcomes of interest. RESULTS: Of 1,414,080 
      CLTI-related hospitalizations, 163,835 (11.6%) were malnourished, 332,855 (23.5%) 
      patients were frail, 917,390 (64.9%) were well-nourished. In-hospital mortality, 
      major amputation, the average length of stay, and hospital costs were highest 
      among malnourished or frail patients and lowest in well-nourished patients 
      (p < 0.001). Malnourished and frail patients were observed to have lower rates of 
      mortality with endovascular revascularization as compared to surgical (adjusted 
      odds ratios: 0.675 [0.533-0.854; p = 0.001]). CONCLUSION: Many patients with CLTI 
      are malnourished or frail, and this is associated with mortality and amputation. 
      Both malnourished and frail patients were observed to have a mortality benefit 
      with a less invasive approach to revascularization. Better assessment of 
      nutritional and frailty status of CLTI patients may guide therapy and help 
      prevent amputation and death.
CI  - (c) 2022 Wiley Periodicals LLC.
FAU - Karim, Adham M
AU  - Karim AM
AUID- ORCID: 0000-0002-7658-6488
AD  - Department of Cardiovascular Medicine, Gill Heart and Vascular Institute, 
      University of Kentucky, Lexington, Kentucky, USA.
FAU - Li, Jun
AU  - Li J
AUID- ORCID: 0000-0002-2064-4992
AD  - Department of Cardiovascular Medicine, Harrington Heart & Vascular Institute, 
      University Hospitals, Cleveland, Ohio, USA.
FAU - Panhwar, Muhammad S
AU  - Panhwar MS
AD  - Department of Cardiovascular Medicine, Tulane University Heart and Vascular 
      Institute, Tulane University School of Medicine, New Orleans, Louisiana, USA.
FAU - Arshad, Samiullah
AU  - Arshad S
AD  - Department of Cardiovascular Medicine, Gill Heart and Vascular Institute, 
      University of Kentucky, Lexington, Kentucky, USA.
FAU - Shalabi, Shihabaldean
AU  - Shalabi S
AD  - Department of Cardiovascular Medicine, Gill Heart and Vascular Institute, 
      University of Kentucky, Lexington, Kentucky, USA.
FAU - Mena-Hurtado, Carlos
AU  - Mena-Hurtado C
AD  - Vascular Medicine Outcomes Program, Section of Cardiovascular Medicine, Yale 
      University, New Haven, Connecticut, USA.
FAU - Aronow, Herbert D
AU  - Aronow HD
AD  - Division of Cardiology, Alpert Medical School of Brown University, Providence, 
      Rhode Island, USA.
FAU - Secemsky, Eric A
AU  - Secemsky EA
AD  - Smith Center for Outcomes Research in Cardiology, Division of Cardiology, Beth 
      Israel Deaconess Hospital, Boston, Massachusetts, USA.
FAU - Shishehbor, Mehdi H
AU  - Shishehbor MH
AUID- ORCID: 0000-0002-4888-2431
AD  - Department of Cardiovascular Medicine, Harrington Heart & Vascular Institute, 
      University Hospitals, Cleveland, Ohio, USA.
LA  - eng
PT  - Journal Article
DEP - 20220203
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  - Amputation, Surgical
MH  - Chronic Disease
MH  - Chronic Limb-Threatening Ischemia
MH  - *Endovascular Procedures/adverse effects
MH  - *Frailty
MH  - Humans
MH  - Ischemia/diagnosis/surgery
MH  - Limb Salvage
MH  - *Malnutrition/diagnosis/etiology/surgery
MH  - *Peripheral Arterial Disease/diagnosis/surgery
MH  - Risk Factors
MH  - Time Factors
MH  - Treatment Outcome
OTO - NOTNLM
OT  - cardiac
OT  - critical
OT  - economica/cost-effectiveness
OT  - endovascular intervention
OT  - limb ischemia
OT  - metabolism
OT  - peripheral arterial disease
OT  - risk stratification
EDAT- 2022/02/04 06:00
MHDA- 2022/04/22 06:00
CRDT- 2022/02/03 17:18
PHST- 2021/12/29 00:00 [revised]
PHST- 2021/11/08 00:00 [received]
PHST- 2022/01/21 00:00 [accepted]
PHST- 2022/02/04 06:00 [pubmed]
PHST- 2022/04/22 06:00 [medline]
PHST- 2022/02/03 17:18 [entrez]
AID - 10.1002/ccd.30113 [doi]
PST - ppublish
SO  - Catheter Cardiovasc Interv. 2022 Mar;99(4):1300-1309. doi: 10.1002/ccd.30113. 
      Epub 2022 Feb 3.