Objective
The aim of this study was to create prediction models for two year overall survival
(OS) and amputation free survival (AFS) after revascularisation in patients with chronic
limb threatening ischaemia (CLTI).
Methods
This was a retrospective analysis of prospectively collected multicentre registry
data (JAPAN Critical Limb Ischaemia Database; JCLIMB). Data from 3 505 unique patients
with CLTI who had undergone revascularisation from 2013 to 2017 were extracted from
the JCLIMB for the analysis. The cohort was randomly divided into development (2 861
patients) and validation cohorts (644 patients). In the development cohort, multivariable
risk models were constructed to predict two year OS and AFS using Cox proportional
hazard regression analysis. These models were applied to the validation cohort and
their performances were evaluated using Harrell’s C index and calibration plots.
Results
Kaplan–Meier estimates of two year OS and AFS post-revascularisation in the whole
cohort were 69% and 62%, respectively. Strong predictors for OS consisted of age,
activity, malignant neoplasm, chronic kidney disease (CKD), congestive heart failure
(CHF), geriatric nutritional risk index (GNRI), and sex. Strong predictors for AFS
included age, activity, malignant neoplasm, CKD, CHF, GNRI, body temperature, white
blood cells, urgent revascularisation procedure, and sex. Prediction models for two
year OS and AFS showed good discrimination with Harrell’s C indexes of 0.73 (95% confidence
interval [CI] 0.69 – 0.77) and 0.72 (95% CI 0.68 – 0.76), respectively
Conclusion
Prediction models for two year OS and AFS post-revascularisation in patients with
CLTI were created. They can assist in determining treatment strategies and serve as
risk adjustment modalities for quality benchmarking for revascularisation in patients
with CLTI at each facility.
Keywords
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Article info
Publication history
Published online: June 06, 2022
Accepted:
May 29,
2022
Received:
December 25,
2021
Identification
Copyright
© 2022 European Society for Vascular Surgery. Published by Elsevier B.V. All rights reserved.
