Association between CRP/Albumin ratio and long-term mortality in patients with cHronIc Limb-threatening ischemia undergoing EndovaScular therapy Below The Knee: The ACHILES-BTK Registry

Abstract Funding Acknowledgements Type of funding sources: None. Background Patients with heart failure with reduced ejection fraction (HFrEF) who received implantable cardiac defibrillator (ICD) still remain at high risk due to pump failure and comorbid conditions. C-reactive protein to albumin ratio (CAR) may be of value for identifying those with high risk for mortality despite ICD implantation. Methods Those who were implanted ICD for HFrEF in our institution between 2009 and 2019 were included. CAR was calculated as ratio of C-reactive protein (CRP) to serum albumin concentration. Patients were grouped into tertiles in accordance to CAR at the time of implantation. After follow up of 48 ± 35 months, survival times of tertiles were compared by using Kaplan-Meier survival method. Results Thousand and eleven patients constituted study population. Ischemic cardiomyopathy was primary diagnosis in 92.3%. Of those 14.5% had died after discharge. Patients in tertile 3 (T3) had higher risk of appropriate shock (19.3% vs 23.7% vs 38.0%) and mortality (4.2% vs 11.0% vs 28.5%) compared to those in other tertiles. Multivariable analysis revealed that when patients in T1 were considered as reference, both those in T2 and T3 had independently higher risk of appropriate shocks and mortality. These effects were consistent in the unadjusted and adjusted multivariable models. Conclusion Among patients with HFrEF and ICD, elevated CAR increased the risk of appropriate device shock and mortality at long term. Table 1Admission C-reactive protein/Albumin ratio (n = 1011)T1 (n = 337)T2 (n = 337)T3 (n = 337)Mortality, %4.211.028.5Mortality, HR (95% CI)Model 1: unadjusted1[Reference]3.85 (2.12 - 11.20)8.14 (2.46 - 28.56)Model 2: adjusted for age, sex1[Reference]3.20 (1.90 - 9.48)6.32 (2.12 - 20.12)Model 3: adjusted for comorbiditesa1[Reference]4.85 (2.06 - 14.12)10.86 (4.12 - 44.82)Model 4: adjusted for covariatesb1[Reference]2.72 (1.66 - 7.12)5.72 (2.04 - 18.05)Frequency, %19.323.738.0Appropriate shock, HR (95% CI)Model 1: unadjusted1[Reference]1.38 (0.44 - 6.88)2.48 (1.34 - 5.82)Model 2: adjusted for age, sex1[Reference]1.42 (0.48 - 7.24)3.02 (1.52 - 6.24)Model 3: adjusted for comorbiditesa1[Reference]1.34 (0.38 - 6.66)2.74 (1.40 - 7.28)Model 4: adjusted for covariatesb1[Reference]1.30 (0.34 - 5.68)2.28 (1.16 - 8.28)Cox proportional analysis and logistic regression models for the appropriate shock and the long-term mortality by CAR.Abstract Figure 1

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The Baseline Nutritional Status Predicts Long-Term Mortality in Patients Undergoing Endovascular Therapy

Nutrients ◽

10.3390/nu11081745 ◽

2019 ◽

Vol 11 (8) ◽

pp. 1745 ◽

Cited By ~ 2

Author(s):

Keiko Mizobuchi ◽

Kentaro Jujo ◽

Yuichiro Minami ◽

Issei Ishida ◽

Masashi Nakao ◽

...

Keyword(s):

Nutritional Status ◽

Peripheral Artery Disease ◽

Endovascular Therapy ◽

Cholesterol Concentration ◽

Left Ventricular Ejection ◽

Peripheral Artery ◽

Artery Disease ◽

Conut Score ◽

Long Term Mortality

Introduction: Peripheral artery disease (PAD) occurs at an advanced stage of atherosclerosis and its comorbidities are associated with poor prognoses. Malnutrition is related to the severity of atherosclerosis in patients with cardiovascular disease and it predicts mortality. The Controlling Nutritional Status (CONUT) score is calculated from serum albumin concentration, peripheral lymphocyte count and total cholesterol concentration, and it robustly represents the nutritional status of hospitalized patients. This study aimed to determine the prognostic value of the CONUT score in patients with peripheral artery disease (PAD) who were undergoing endovascular therapy (EVT). METHODS and RESULTS: This study included 628 PAD patients who underwent EVT between 2013 and 2017 and were assigned to low (CONUT score 0: n = 81), mild (CONUT score 1–2: n = 250), moderate (CONUT score 3–4: n = 169), and high (CONUT score ≥ 5: n = 128) risk groups. The study’s primary endpoint was any death. Patients in the groups with higher CONUT scores were more likely to have chronic kidney disease (p < 0.001), impaired left ventricular ejection fractions (p < 0.001), and critical limb ischemia (p < 0.001) on admission. During follow-up, 95 patients (15%) died. Kaplan–Meier analyses revealed that the patients with higher CONUT scores had lower survival rates (p < 0.001; log-rank trend test). Multivariate Cox regression analyses showed that following adjustments for the confounding factors, a higher CONUT score was significantly associated with any death (hazard ratio, 1.15; 95% confidence interval, 1.03–1.30). CONCLUSION: The simple index CONUT score at the time of EVT may predict long-term mortality in PAD patients.

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