Background:The aim of this study was to develop a predictive model for mortality risk based on preoperative risk factors, including the Wound, Ischemia, Foot Infection (WIfI) classification, in patients undergoing revascularization for critical limb ischemia.Methods:We analyzed a database of the Surgical reconstruction versus Peripheral Intervention in Patients With Critical Limb Ischemia registry, a multicenter, prospective, observational study that included 520 critical limb ischemia patients (192 surgical and 328 endovascular patients).Results:Multivariate Cox regression analysis identified old age, impaired mobility, low body mass index, renal failure, heart failure, and high WIfI grade as independent risk factors for all-cause mortality (all P<0.05). The risk score comprising these risk factors discriminated the mortality risk well; the 2-year survival rate was >90% in the first quantile of the risk score and ≈20% in the fifth quantile. The area under the time-dependent receiver operating characteristics curve was 0.829 for thirty-day mortality and 0.811 for 2-year mortality. Adding more detailed preoperative information to the predictive model revealed that cystatin C-based estimated glomerular filtration rate, left ventricular ejection fraction, and cholinesterase levels were additional independent risk factors, but the predictive accuracy of the model was not significantly improved, according to the time-dependent receiver operating characteristics curve and net reclassification improvement.Conclusions:The current study developed a risk score for mortality using preoperative risk factors, including the WIfI classification, in critical limb ischemia patients undergoing revascularization.

中文翻译：

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严重肢体缺血血运重建患者的死亡，包括伤口，局部缺血，足部感染等死亡风险的预测模型。

背景：本研究的目的是基于术前危险因素（包括伤口，局部缺血，足部感染（WIfI）分类）为重度肢体缺血进行血运重建的患者建立死亡率风险的预测模型。方法：我们分析了一个数据库多中心，前瞻性，观察性研究对重度肢体缺血登记患者的手术重建与周围干预进行了比较，该研究包括520例重度肢体缺血患者（192例外科手术和328例血管内患者）。结果：多因素Cox回归分析确定了老年人，活动性受损，低体重指数，肾功能衰竭，心力衰竭和WIfI等级高是全因死亡率的独立危险因素（所有P<0.05）。包含这些风险因素的风险评分很好地区分了死亡风险；风险评分的第一个分位数的2年生存率> 90％，第五个分位数的2年生存率约为20％。随时间变化的接收器工作特性曲线下的面积，30天死亡率为0.829，2年死亡率为0.811。在预测模型中添加更多详细的术前信息后发现，基于半胱氨​​酸蛋白酶抑制剂C的估计肾小球滤过率，左心室射血分数和胆碱酯酶水平是另外的独立危险因素，但根据时间，模型的预测准确性并未显着提高依赖的接收器工作特性曲线和净重分类改进。