PMID- 37704093
OWN - NLM
STAT- MEDLINE
DCOM- 20231225
LR  - 20231225
IS  - 1097-6809 (Electronic)
IS  - 0741-5214 (Linking)
VI  - 79
IP  - 1
DP  - 2024 Jan
TI  - The association of comorbid depression with mortality and amputation risk in 
      patients with chronic limb-threatening ischemia.
PG  - 96-101.e1
LID - S0741-5214(23)01944-4 [pii]
LID - 10.1016/j.jvs.2023.09.001 [doi]
AB  - OBJECTIVE: There is increasing evidence that depression is a risk factor for 
      worse outcomes in patients with peripheral artery disease. The association of 
      depression in patients with chronic limb-threatening ischemia (CLTI) is not well 
      described, nor is the impact of medical treatment for depression in this patient 
      population. The objective of this study was to investigate the prevalence of 
      depression in patients with CLTI, its association on major amputation and 
      all-cause mortality, and whether medical antidepressant treatment is associated 
      with improvement in these outcomes in patients with depression. METHODS: A 
      retrospective review of all adult patients (>/=18 years old) diagnosed with CLTI 
      from January 1, 2007, to December 31, 2018, at a single academic medical center 
      was performed. Collected data included patient demographics, comorbidities, and 
      diagnosis of depression within 6 months of initial CLTI diagnosis. We also 
      collected data on use of antidepressant medications. Outcomes evaluated were need 
      for major lower extremity amputation and all-cause mortality. Multivariable 
      logistic regression models estimated the adjusted effects of comorbid depression 
      and antidepressant medication use on major amputation and all-cause mortality. 
      Kaplan-Meier survival curves illustrated the probabilities of survival and limb 
      salvage over time, stratified by diagnosis of comorbid depression. Multivariable 
      Cox proportional hazards models estimated the adjusted effects of comorbid 
      depression on time to major amputation and all-cause mortality, and the adjusted 
      effect of antidepressant treatment on time to all-cause mortality. RESULTS: A 
      total of 2987 patients with CLTI were identified. Mean age was 68.6 years 
      (standard deviation, 12.9 years); 56.5% were male, and 43.5% were female. 
      Comorbid depression within 6 months of CLTI diagnosis was present in 7.1% of the 
      cohort (212 patients). In multivariable analysis, comorbid depression was 
      associated with a 68% increase in the odds of major amputation (adjusted odds 
      ratio [aOR], 1.68; 95% confidence interval [CI], 1.19-2.37; P < .01), a 164% 
      increase in the odds of all-cause mortality among patients not taking 
      antidepressants (aOR, 2.64; 95% CI, 1.31-5.32; P = .03), and only a 6% increase 
      in the odds of all-cause mortality among patients taking antidepressants (aOR, 
      1.06; 95% CI, 0.72-1.55; P = .99). The effect of comorbid depression on mortality 
      varied significantly by whether or not the patient was taking an antidepressant 
      medication (P = .02). CONCLUSIONS: Comorbid depression in the patient population 
      with CLTI is associated with a worse prognosis for major lower extremity 
      amputation overall, and a worse prognosis for all-cause mortality among patients 
      not taking an antidepressant. Furthermore, antidepressant treatment in the 
      presence of comorbid depression in this patient population is associated with an 
      improvement in the odds of all-cause mortality, illustrating the potential 
      importance of medical management of depression.
CI  - Published by Elsevier Inc.
FAU - Zielke, Tara
AU  - Zielke T
AD  - Loyola University Chicago Stritch School of Medicine, Maywood, IL.
FAU - Korepta, Lindsey
AU  - Korepta L
AD  - Division of Vascular Surgery and Endovascular Therapy, Department of Surgery, 
      Loyola University Medical Center, Maywood, IL.
FAU - Wesolowski, Michael
AU  - Wesolowski M
AD  - Loyola University of Chicago Clinical Research Office Biostatistics Core, 
      Maywood, IL.
FAU - D'Andrea, Melissa
AU  - D'Andrea M
AD  - University of Arizona College of Medicine Tucson, Tucson, AZ.
FAU - Aulivola, Bernadette
AU  - Aulivola B
AD  - Division of Vascular Surgery and Endovascular Therapy, Department of Surgery, 
      Loyola University Medical Center, Maywood, IL. Electronic address: 
      baulivola@lumc.edu.
LA  - eng
PT  - Journal Article
DEP - 20230912
PL  - United States
TA  - J Vasc Surg
JT  - Journal of vascular surgery
JID - 8407742
RN  - 0 (Antidepressive Agents)
SB  - IM
MH  - Adult
MH  - Humans
MH  - Male
MH  - Female
MH  - Aged
MH  - Adolescent
MH  - Chronic Limb-Threatening Ischemia
MH  - Depression/diagnosis/epidemiology
MH  - Treatment Outcome
MH  - Ischemia/diagnosis/epidemiology/surgery
MH  - Chronic Disease
MH  - Risk Factors
MH  - *Peripheral Arterial Disease/diagnosis/epidemiology/surgery
MH  - Limb Salvage
MH  - Antidepressive Agents/therapeutic use
MH  - Amputation, Surgical
MH  - Retrospective Studies
MH  - *Endovascular Procedures/adverse effects
OTO - NOTNLM
OT  - Critical limb-threatening ischemia (CLTI)
OT  - Depression
OT  - Peripheral artery disease (PAD)
COIS- Disclosures None.
EDAT- 2023/09/14 00:42
MHDA- 2023/12/25 06:43
CRDT- 2023/09/13 19:16
PHST- 2023/05/18 00:00 [received]
PHST- 2023/08/28 00:00 [revised]
PHST- 2023/09/03 00:00 [accepted]
PHST- 2023/12/25 06:43 [medline]
PHST- 2023/09/14 00:42 [pubmed]
PHST- 2023/09/13 19:16 [entrez]
AID - S0741-5214(23)01944-4 [pii]
AID - 10.1016/j.jvs.2023.09.001 [doi]
PST - ppublish
SO  - J Vasc Surg. 2024 Jan;79(1):96-101.e1. doi: 10.1016/j.jvs.2023.09.001. Epub 2023 
      Sep 12.