El impacto del estado nutricional e inflamatorio en los pacientes con isquemia crítica de miembros inferiores

BACKGROUND Peripheral arterial disease (PAD) is a disease with a high prevalence and is an independent risk factor for mortality. It is a chronic inflammatory disease and a proinflammatory state enhances its development and progression. Moreover, malnutrition has been shown to be an independent fact...

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Autor: García Rivera, Elena
Tipo de recurso: tesis doctoral
Estado:Versión publicada
Fecha de publicación:2024
País:España
Institución:Universidad de Valladolid
Repositorio:UVaDOC. Repositorio Documental de la Universidad de Valladolid
OAI Identifier:oai:uvadoc.uva.es:10324/71475
Acceso en línea:https://doi.org/10.35376/10324/71475
https://uvadoc.uva.es/handle/10324/71475
Access Level:acceso abierto
Palabra clave:Isquemia
Ischemia
Enfermedad arterial periférica
Nutrition assessment
Biomarcadores
Mortality
Albúmina sérica
32 Ciencias Médicas
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dc.title.none.fl_str_mv El impacto del estado nutricional e inflamatorio en los pacientes con isquemia crítica de miembros inferiores
title El impacto del estado nutricional e inflamatorio en los pacientes con isquemia crítica de miembros inferiores
spellingShingle El impacto del estado nutricional e inflamatorio en los pacientes con isquemia crítica de miembros inferiores
García Rivera, Elena
Isquemia
Ischemia
Enfermedad arterial periférica
Nutrition assessment
Biomarcadores
Mortality
Albúmina sérica
32 Ciencias Médicas
title_short El impacto del estado nutricional e inflamatorio en los pacientes con isquemia crítica de miembros inferiores
title_full El impacto del estado nutricional e inflamatorio en los pacientes con isquemia crítica de miembros inferiores
title_fullStr El impacto del estado nutricional e inflamatorio en los pacientes con isquemia crítica de miembros inferiores
title_full_unstemmed El impacto del estado nutricional e inflamatorio en los pacientes con isquemia crítica de miembros inferiores
title_sort El impacto del estado nutricional e inflamatorio en los pacientes con isquemia crítica de miembros inferiores
dc.creator.none.fl_str_mv García Rivera, Elena
author García Rivera, Elena
author_facet García Rivera, Elena
author_role author
dc.contributor.none.fl_str_mv Vaquero Puerta, Carlos
San Norberto García, Enrique María
Universidad de Valladolid. Escuela de Doctorado
dc.subject.none.fl_str_mv Isquemia
Ischemia
Enfermedad arterial periférica
Nutrition assessment
Biomarcadores
Mortality
Albúmina sérica
32 Ciencias Médicas
topic Isquemia
Ischemia
Enfermedad arterial periférica
Nutrition assessment
Biomarcadores
Mortality
Albúmina sérica
32 Ciencias Médicas
description BACKGROUND Peripheral arterial disease (PAD) is a disease with a high prevalence and is an independent risk factor for mortality. It is a chronic inflammatory disease and a proinflammatory state enhances its development and progression. Moreover, malnutrition has been shown to be an independent factor of poor prognosis, increasing postoperative complications and mortality. Since inflammatory and nutritional status are closely related, nutritional and inflammatory biomarkers such as the neutrophil/lymphocyte ratio (NLR), platelet/lymphocyte ratio (PLR) and lymphocyte/monocyte ratio (LMR), the CONUT (Controlling Nutritional Status) index and the Prognostic Nutritional Index (PNI) have been described and could be very useful in predicting the prognosis of patients with critical ischemia. OBJECTIVE The primary endpoint was to establish the correlation between different pre-operative biomarkers with short and medium-term mortality and morbidity (6 and 12 months) in patients with critical limb-threatening ischaemia (CTLI) undergoing revascularisation. METHODS Retrospective observational cohort study on a prospective database that included all consecutive patients diagnosed with a first episode of CLTI revascularized from January 2016 to December 2020. Laboratory and demographic data were collected within the first 48 hours of admission. Postsurgical complications, major amputations and mortality at 6 and 12 months were recorded according to risk groups defined by preoperative biomarkers. RESULTS A total of 340 patients were included. Patients with high CONUT (p=0.000), NLR (p=0.000) and PLR (p=0.004) values, as well as low PNI values (p=0.000) had lower survival in the first six months. No significant differences were found for LMR (p=0.060). Regarding mid-term mortality, patients with high NLR (p=0.000), PLR (p=0.003) and CONUT (p=0.000) values, as well as low PNI (p=0.000) and LMR (p=0.000) values had lower survival. A CONUT index above 4.00 was the only independent biomarker that was related to both short and medium-term mortality (p=0.003 and p=0.001, respectively). A high CONUT value was also an independent marker equivalent to other risk factors such as hypertension, age or chronic kidney disease. Regarding short-term major amputations, only patients with high NLR and low PNI valued had lower amputation-free rates (p=0.000 and p=0.005, respectively), with no differences observed with other biomarkers. Regarding mid-term amputations, patients with high NLR (p=0.000), PLR (p=0.004) and CONUT (p=0.001), as well as low PNI (p=0.004) values had a shorter amputation-free rates with no differences in LMR. The only independent marker that was related with short and medium-term major amputations was a PNI below 44.45 (p=0.047 and p=0.035). However, when the PNI was compared to other risk factors, it was not a comparable biomarker to other risk factors such as reinterventions or DM. CONCLUSIONS Preoperative biomarkers based on nutritional and inflammatory parameters are very useful in predicting short and medium-term mortality. Also, the CONUT index is an independent marker of mortality equivalent to other risk factors. For major amputations, PNI could be a useful predictor biomarker. Due to the close relationship of nutritional status with inflammation and its role in the prognosis of CLTI, a simple blood test can be used to obtain preoperative index that identify vulnerable patients with a higher risk of postoperative morbidity and mortality.
publishDate 2024
dc.date.none.fl_str_mv 2024
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dc.identifier.none.fl_str_mv https://doi.org/10.35376/10324/71475
https://uvadoc.uva.es/handle/10324/71475
url https://doi.org/10.35376/10324/71475
https://uvadoc.uva.es/handle/10324/71475
dc.language.none.fl_str_mv Español
language_invalid_str_mv Español
dc.rights.none.fl_str_mv info:eu-repo/semantics/openAccess
http://creativecommons.org/licenses/by-nc-nd/4.0/
eu_rights_str_mv openAccess
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dc.source.none.fl_str_mv reponame:UVaDOC. Repositorio Documental de la Universidad de Valladolid
instname:Universidad de Valladolid
instname_str Universidad de Valladolid
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spelling El impacto del estado nutricional e inflamatorio en los pacientes con isquemia crítica de miembros inferioresGarcía Rivera, ElenaIsquemiaIschemiaEnfermedad arterial periféricaNutrition assessmentBiomarcadoresMortalityAlbúmina sérica32 Ciencias MédicasBACKGROUND Peripheral arterial disease (PAD) is a disease with a high prevalence and is an independent risk factor for mortality. It is a chronic inflammatory disease and a proinflammatory state enhances its development and progression. Moreover, malnutrition has been shown to be an independent factor of poor prognosis, increasing postoperative complications and mortality. Since inflammatory and nutritional status are closely related, nutritional and inflammatory biomarkers such as the neutrophil/lymphocyte ratio (NLR), platelet/lymphocyte ratio (PLR) and lymphocyte/monocyte ratio (LMR), the CONUT (Controlling Nutritional Status) index and the Prognostic Nutritional Index (PNI) have been described and could be very useful in predicting the prognosis of patients with critical ischemia. OBJECTIVE The primary endpoint was to establish the correlation between different pre-operative biomarkers with short and medium-term mortality and morbidity (6 and 12 months) in patients with critical limb-threatening ischaemia (CTLI) undergoing revascularisation. METHODS Retrospective observational cohort study on a prospective database that included all consecutive patients diagnosed with a first episode of CLTI revascularized from January 2016 to December 2020. Laboratory and demographic data were collected within the first 48 hours of admission. Postsurgical complications, major amputations and mortality at 6 and 12 months were recorded according to risk groups defined by preoperative biomarkers. RESULTS A total of 340 patients were included. Patients with high CONUT (p=0.000), NLR (p=0.000) and PLR (p=0.004) values, as well as low PNI values (p=0.000) had lower survival in the first six months. No significant differences were found for LMR (p=0.060). Regarding mid-term mortality, patients with high NLR (p=0.000), PLR (p=0.003) and CONUT (p=0.000) values, as well as low PNI (p=0.000) and LMR (p=0.000) values had lower survival. A CONUT index above 4.00 was the only independent biomarker that was related to both short and medium-term mortality (p=0.003 and p=0.001, respectively). A high CONUT value was also an independent marker equivalent to other risk factors such as hypertension, age or chronic kidney disease. Regarding short-term major amputations, only patients with high NLR and low PNI valued had lower amputation-free rates (p=0.000 and p=0.005, respectively), with no differences observed with other biomarkers. Regarding mid-term amputations, patients with high NLR (p=0.000), PLR (p=0.004) and CONUT (p=0.001), as well as low PNI (p=0.004) values had a shorter amputation-free rates with no differences in LMR. The only independent marker that was related with short and medium-term major amputations was a PNI below 44.45 (p=0.047 and p=0.035). However, when the PNI was compared to other risk factors, it was not a comparable biomarker to other risk factors such as reinterventions or DM. CONCLUSIONS Preoperative biomarkers based on nutritional and inflammatory parameters are very useful in predicting short and medium-term mortality. Also, the CONUT index is an independent marker of mortality equivalent to other risk factors. For major amputations, PNI could be a useful predictor biomarker. Due to the close relationship of nutritional status with inflammation and its role in the prognosis of CLTI, a simple blood test can be used to obtain preoperative index that identify vulnerable patients with a higher risk of postoperative morbidity and mortality.INTRODUCCIÓN La enfermedad arterial periférica (EAP) es una enfermedad con una elevada prevalencia siendo factor de riesgo independiente para mortalidad. Se trata de una enfermedad inflamatoria crónica y un estado proinflamatorio favorece su desarrollo y progresión. Por otra parte, la desnutrición ha demostrado ser un factor independiente de mal pronóstico, incrementando las complicaciones postoperatorias y la mortalidad. Dado que el estado inflamatorio y nutricional está estrechamente relacionado, se han descrito biomarcadores nutricionales e inflamatorios como el ratio neutrófilo/linfocito (NLR), ratio plaqueta/linfocito (PLR) y el ratio linfocito/monocito (LMR), el índice CONUT (Controlling Nutritional Status) y el Índice Pronóstico Nutricional (PNI) que podrían ser muy útiles en la predicción del pronóstico de los pacientes con isquemia crítica. OBJETIVO Estudiar la utilidad de los diferentes marcadores inflamatorios y nutricionales preoperatorios para conocer la evolución postoperatoria a corto y medio plazo (6 y 12 meses) en los pacientes con isquemia crítica de extremidades inferiores sometidos a una cirugía de revascularización. METODOLOGÍA Estudio observacional de cohortes retrospectivo sobre una base de datos prospectiva. Se incluyeron todos los pacientes consecutivos diagnosticados de un primer episodio de isquemia crítica de extremidades inferiores que se sometieron a cirugía de revascularización entre enero de 2016 hasta diciembre de 2020. Se recogieron los datos analíticos y demográficos en las primeras 48 horas de ingreso. Posteriormente se registraron las complicaciones postquirúrgicas, las amputaciones mayores y la mortalidad a los a los seis y a los doce meses en función de grupos de riesgo definidos por los biomarcadores preoperatorios. RESULTADOS Se incluyeron un total de 340 pacientes. Los pacientes con valores elevados de CONUT (p=0.000), NLR (p=0.000) y PLR (p=0.004), así como valores bajos de PNI (p=0.000) presentaron una menor supervivencia en los primeros seis meses. En cuanto al LMR no se hallaron diferencias significativas (p=0.060). Respecto a la mortalidad a medio plazo, los pacientes con valores elevados de NLR (p=0.000), PLR (p=0.003) y CONUT (p=0.000), así como valores bajos de PNI (p=0.000) y LMR (p=0.000) presentaron una menor supervivencia. El único marcador independiente que se relacionó tanto con mortalidad a corto como a medio plazo fue un índice CONUT superior a 4.00 (p=0.003 y p=0.001, respectivamente). Un CONUT elevado fue marcador independiente equivalente a otros factores de riesgo como la hipertensión arterial, la edad o la enfermedad renal crónica. En cuanto a las amputaciones mayores a corto plazo, únicamente los pacientes con un NLR elevado así como un PNI bajo presentaron un menor tiempo libre de amputación (p=0.000 y p=0.005, respectivamente), sin observarse diferencias en el resto de biomarcadores. En cuanto a las amputaciones a medio plazo, los pacientes con valores elevados de NLR (p=0.000), PLR (p=0.004) y CONUT (p=0.001), así como un PNI bajo (p=0.004) presentaron un menor tiempo libre de amputación sin observarse diferencias en el LMR. El único marcador independiente que se relacionó con amputaciones a corto y medio plazo fue un índice PNI inferior a 44.45 (p=0.047 y p=0.035). Sin embargo, cuando se comparó con el resto de factores de riesgo no demostró ser un marcador equiparable a otros factores de riesgo como las reintervenciones o la DM. CONCLUSIONES Los biomarcadores preoperatorios basados en parámetros nutricionales e inflamatorios son de gran utilidad en predecir mortalidad a corto y medio plazo, siendo el CONUT marcador independiente de mortalidad equivalente a otros factores de riesgo. En cuanto a las amputaciones mayores, el PNI podría ser un marcador predictor de utilidad. Dada la estrecha relación del estado nutricional con la inflamación y su papel en el pronóstico de la isquemia crítica, con este sencillo análisis se pueden obtener índices preoperatorios que identifican pacientes vulnerables con mayor riesgo de morbi-mortalidad postoperatoria.Escuela de DoctoradoDoctorado en Investigación en Ciencias de la SaludVaquero Puerta, CarlosSan Norberto García, Enrique MaríaUniversidad de Valladolid. Escuela de Doctorado2024info:eu-repo/semantics/doctoralThesisinfo:eu-repo/semantics/publishedVersionapplication/pdfhttps://doi.org/10.35376/10324/71475https://uvadoc.uva.es/handle/10324/71475reponame:UVaDOC. Repositorio Documental de la Universidad de Valladolidinstname:Universidad de ValladolidEspañolinfo:eu-repo/semantics/openAccesshttp://creativecommons.org/licenses/by-nc-nd/4.0/oai:uvadoc.uva.es:10324/714752026-06-13T12:44:47Z
score 15,811543

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