Association Between Undernutrition and Mortality and Amputation Outcomes in Chronic Limb Threatening Ischaemia: A Systematic Review.

IF 5.7 1区医学 Q1 PERIPHERAL VASCULAR DISEASE

European Journal of Vascular and Endovascular Surgery Pub Date : 2024-08-30 DOI:10.1016/j.ejvs.2024.08.038

Lindsey E Scierka, Jacob Cleman, Aaron E Brice, Alyssa A Grimshaw, Sabita S Soedamah-Muthu, Carlos Mena-Hurtado, Kim G Smolderen

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引用次数: 0

Abstract

Objective: Nutritional status plays a complex role in the pathophysiology and outcomes of chronic limb threatening ischaemia (CLTI). Undernutrition may be a modifiable risk factor. Given the variability in nutritional status concepts in CLTI outcomes studies, a systematic review examining the association between undernutrition and outcomes in patients with CLTI was conducted.

Data sources: A systematic literature search of nine databases (Allied and Complementary Medicine Database [AMED], CINAHL Complete, Cochrane Library, Google Scholar, Ovid Medline, Ovid Embase, PubMed, Scopus, and Web of Science Core Collection databases) was conducted up to 23 May 2023.

Review methods: Inclusion criteria were randomised controlled trials, cohort studies, and case control studies of patients with CLTI conducted after 1982 that reported the effect size for a nutritional status measure and the outcomes of death, amputation, or a composite of the two. Two reviewers independently performed screening, data extraction, and quality assessment, with a third independent reviewer resolving conflicts.

Results: A total of 6 818 citations were screened, with 49 observational studies (31 from Japan) included in the review. The mean patient age ranged from 56.0 - 86.9 years. Most included patients were undergoing revascularisation. Unidimensional indicators of undernutrition (including low serum albumin, low body mass index, and zinc deficiency) as well as multidimensional measures (such as nutritional screening tool scores indicating undernutrition) were found to be associated with a statistically significant increased risk of death, amputation, and composite events in most studies. Effect sizes of the association were generally larger when multidimensional nutritional screening tools were used. However, the quality of evidence was poor, and certainty of evidence very low.

Conclusion: Undernutrition is consistently associated with an increased risk of death and amputation in patients with CLTI, regardless of the measure used. Broader efforts to understand the framework of nutritional status and validation of nutritional screening tools in CLTI populations are needed.

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营养不良与慢性肢体缺血的死亡率和截肢结果的关系：系统回顾

目的：营养状况在慢性肢体缺血（CLTI）的病理生理学和预后中起着复杂的作用。营养不良可能是一个可改变的风险因素。鉴于慢性肢体缺血危象预后研究中的营养状况概念存在差异，我们对慢性肢体缺血危象患者营养不良与预后之间的关系进行了系统性回顾：数据来源：截至 2023 年 5 月 23 日，对九个数据库（Allied and Complementary Medicine Database [AMED]、CINAHL Complete、Cochrane Library、Google Scholar、Ovid Medline、Ovid Embase、PubMed、Scopus 和 Web of Science Core Collection 数据库）进行了系统性文献检索：纳入标准为1982年后开展的针对CLTI患者的随机对照试验、队列研究和病例对照研究，这些研究报告了营养状况测量的效应大小以及死亡、截肢或两者的综合结果。两名审稿人独立进行筛选、数据提取和质量评估，第三名独立审稿人负责解决冲突：共筛选出 6 818 篇引文，其中 49 篇观察性研究（31 篇来自日本）被纳入综述。患者平均年龄为 56.0 - 86.9 岁。大多数纳入研究的患者正在接受血管重建手术。在大多数研究中，营养不良的单维指标（包括低血清白蛋白、低体重指数和锌缺乏）和多维指标（如表明营养不良的营养筛查工具评分）被发现与死亡、截肢和复合事件风险的统计学显著增加有关。使用多维营养筛查工具时，相关性的效应大小通常更大。然而，证据的质量很差，证据的确定性很低：无论采用哪种测量方法，营养不良始终与CLTI患者死亡和截肢风险的增加有关。需要做出更广泛的努力来了解CLTI人群的营养状况框架并验证营养筛查工具。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

European Journal of Vascular and Endovascular Surgery 医学-外科

CiteScore

6.80

自引率

15.80%

发文量

471

审稿时长

66 days

期刊介绍： The European Journal of Vascular and Endovascular Surgery is aimed primarily at vascular surgeons dealing with patients with arterial, venous and lymphatic diseases. Contributions are included on the diagnosis, investigation and management of these vascular disorders. Papers that consider the technical aspects of vascular surgery are encouraged, and the journal includes invited state-of-the-art articles. Reflecting the increasing importance of endovascular techniques in the management of vascular diseases and the value of closer collaboration between the vascular surgeon and the vascular radiologist, the journal has now extended its scope to encompass the growing number of contributions from this exciting field. Articles describing endovascular method and their critical evaluation are included, as well as reports on the emerging technology associated with this field.