PMID- 37249001 OWN - NLM STAT- MEDLINE DCOM- 20231009 LR - 20231018 IS - 1477-0377 (Electronic) IS - 1358-863X (Linking) VI - 28 IP - 5 DP - 2023 Oct TI - Immunologic profiles in patients with chronic limb-threatening ischemia undergoing endovascular revascularization. PG - 387-396 LID - 10.1177/1358863X231169323 [doi] AB - BACKGROUND: Inflammation and immune dysregulation have been associated with adverse outcomes in cardiovascular disease. There is limited understanding of the association of different profiles of white blood cell (WBC) subsets and red cell distribution width (RDW) in patients with chronic limb-threatening ischemia (CLTI). METHODS: Patients with CLTI undergoing endovascular revascularization in our single-center, tertiary care hospital from 2017 to 2019, who had a preceding complete blood count (CBC) with WBC differentials (n =213), were included in the analysis. Patient characteristics, laboratory values, and clinical outcomes were collected. Cox proportional hazards regression models were used to assess for associations between all-cause mortality and leukocyte subset; multivariate analysis was used to account for confounders. Kaplan-Meier curves were generated to depict survival censored at 1 year postrevascularization using baseline CBC indices. RESULTS: Adjusting for confounders, elevated RDW was associated with increased mortality (continuous per % increase, adjusted hazard ratio [HR] 1.33, p < 0.001). Baseline lymphopenia was associated with mortality in univariate analysis. Other leukocyte subtypes were not associated with mortality outcomes in our population. Exploratory analysis showed negative deflections in ∆WBC from pre- to postprocedure day 1 were affiliated with increased mortality when adjusted for age, sex, race, chronic kidney disease, and baseline hemoglobin (∆WBC HR 1.16, p = 0.004). Further exploratory analysis showed an association between RDW and all-comers readmission. CONCLUSIONS: The utilization of a periprocedural WBC subset differential can be a useful adjunct to risk-stratify patients with CLTI undergoing endovascular revascularization. Further studies are needed to understand potential ways to modulate immune dysregulation so as to improve mortality outcomes. FAU - Li, Jun AU - Li J AUID- ORCID: 0000-0002-2064-4992 AD - Harrington Heart & Vascular Institute, University Hospitals Cleveland Medical Center, Cleveland, OH, USA. FAU - Arora, Shilpkumar AU - Arora S AD - Harrington Heart & Vascular Institute, University Hospitals Cleveland Medical Center, Cleveland, OH, USA. FAU - Wheat, Heather AU - Wheat H AD - Department of Medicine, University Hospitals Cleveland Medical Center, Cleveland, OH, USA. AD - Department of Internal Medicine, Division of Cardiovascular Medicine, University of Michigan, Ann Arbor, MI, USA. FAU - Dash, Siddhartha AU - Dash S AD - School of Medicine, Case Western Reserve University, Cleveland, OH, USA. AD - Promedica University of Toledo, Toledo, OH, USA. FAU - Kimura, Stephen AU - Kimura S AD - School of Medicine, Case Western Reserve University, Cleveland, OH, USA. AD - Division of General Internal Medicine, Emory University School of Medicine, Atlanta, GA, USA. FAU - Smith, Justin AU - Smith J AD - Harrington Heart & Vascular Institute, University Hospitals Cleveland Medical Center, Cleveland, OH, USA. FAU - Castro-Dominguez, Yulanka AU - Castro-Dominguez Y AUID- ORCID: 0000-0003-0620-0444 AD - Harrington Heart & Vascular Institute, University Hospitals Cleveland Medical Center, Cleveland, OH, USA. FAU - Oommen, Clint AU - Oommen C AD - Harrington Heart & Vascular Institute, University Hospitals Cleveland Medical Center, Cleveland, OH, USA. FAU - Hammad, Tarek A AU - Hammad TA AD - Harrington Heart & Vascular Institute, University Hospitals Cleveland Medical Center, Cleveland, OH, USA. FAU - Shishehbor, Mehdi H AU - Shishehbor MH AUID- ORCID: 0000-0002-4888-2431 AD - Harrington Heart & Vascular Institute, University Hospitals Cleveland Medical Center, Cleveland, OH, USA. FAU - Al-Kindi, Sadeer AU - Al-Kindi S AD - Harrington Heart & Vascular Institute, University Hospitals Cleveland Medical Center, Cleveland, OH, USA. FAU - Zidar, David A AU - Zidar DA AD - Harrington Heart & Vascular Institute, University Hospitals Cleveland Medical Center, Cleveland, OH, USA. AD - Louis Stokes Cleveland Veterans Affairs Medical Center, Cleveland, OH, USA. LA - eng PT - Journal Article DEP - 20230530 PL - England TA - Vasc Med JT - Vascular medicine (London, England) JID - 9610930 SB - IM MH - Humans MH - Chronic Limb-Threatening Ischemia MH - Risk Factors MH - *Endovascular Procedures/adverse effects MH - Limb Salvage MH - *Peripheral Arterial Disease/diagnosis/surgery MH - Treatment Outcome MH - Ischemia/diagnosis/surgery MH - Chronic Disease MH - Retrospective Studies OTO - NOTNLM OT - anisocytosis OT - chronic limb-threatening ischemia (CLTI) OT - immune dysregulation OT - lymphopenia COIS- Declaration of conflicting interestsThe authors declared the following potential conflicts of interest with respect to the research, authorship, and/or publication of this article: Dr Li: advisory board for Boston Scientific, Inari Medical, and Medtronic; consultant for Abbott Vascular, Endovascular Engineering, Inquis Medical, and Philips. Dr Shishehbor: global advisory board for Abbott Vascular, Medtronic, Terumo, Philips, Boston Scientific, ANT, and Inquis Medical. Drs Castro-Dominguez, Oommen, and Hammad: consultants for Medtronic. The remaining authors have no disclosures. EDAT- 2023/05/30 06:42 MHDA- 2023/10/09 06:42 CRDT- 2023/05/30 05:28 PHST- 2023/10/09 06:42 [medline] PHST- 2023/05/30 06:42 [pubmed] PHST- 2023/05/30 05:28 [entrez] AID - 10.1177/1358863X231169323 [doi] PST - ppublish SO - Vasc Med. 2023 Oct;28(5):387-396. doi: 10.1177/1358863X231169323. Epub 2023 May 30.