The current study aimed to reveal the clinical impact of plasma homocysteine levels in chronic limb-threatening ischemia (CLTI) patients undergoing revascularization. This was a sub-analysis of a prospective multicenter registry of CLTI patients, named the Surgical reconstruction versus Peripheral INtervention in pAtients with critical limb isCHemia (SPINACH) study. The current analysis included 192 non-dialysis-dependent CLTI patients who underwent revascularization for CLTI, and whose plasma homocysteine levels at baseline were available. The association of clinical characteristics with homocysteine levels was evaluated with the linear regression model. The association of homocysteine levels with the mortality risk was investigated using the Cox proportional hazards regression model. Cystatin C-based estimated glomerular filtration rate (eGFR) was independently associated with log-transformed homocysteine levels; the adjusted standardized regression coefficient (95% confidence interval) was − 0.432 (− 0.657 to − 0.253; P < 0.001). Homocysteine levels were significantly associated with the mortality risk in the univariate model (P = 0.017); the unadjusted hazard ratio was 1.71 (1.13–2.50) per twofold increase. The association was significantly attenuated when adjusted for cystatin C-based eGFR (P < 0.001); the hazard ratio adjusted for cystatin C-based eGFR was 1.28 (0.80–1.90; P = 0.29). An apparent association of homocysteine levels with an increased risk of mortality could be explained by renal dysfunction. Future studies will be needed to validate the current findings.

目前的研究旨在揭示血浆同型半胱氨酸水平对接受血运重建的慢性肢体威胁性缺血（CLTI）患者的临床影响。这是对 CLTI 患者前瞻性多中心登记的子分析，命名为严重肢体缺血患者的手术重建与外周干预 (SPINACH) 研究。目前的分析包括 192 名非透析依赖性 CLTI 患者，他们接受了 CLTI 血运重建，并且其基线血浆同型半胱氨酸水平可用。使用线性回归模型评估临床特征与同型半胱氨酸水平的关联。使用 Cox 比例风险回归模型研究了同型半胱氨酸水平与死亡风险的关联。基于胱抑素 C 的估计肾小球滤过率 (eGFR) 与对数转换的同型半胱氨酸水平独立相关；调整后的标准化回归系数（95% 置信区间）为 - 0.432（- 0.657 至 - 0.253；P  < 0.001)。在单变量模型中，同型半胱氨酸水平与死亡风险显着相关（P  = 0.017）；未经调整的风险比为每增加两倍 1.71 (1.13–2.50)。当调整基于胱抑素 C 的 eGFR 时，该关联显着减弱（P  < 0.001）；调整基于胱抑素 C 的 eGFR 的风险比为 1.28（0.80-1.90；P  = 0.29）。肾功能不全可以解释同型半胱氨酸水平与死亡风险增加的明显关联。未来的研究将需要验证当前的发现。