Mutual Effect of Nutritional Status and Inflammatory Processon Mortality after Superficial Artery Intervention: NAPLES Score.

Abstract

Introduction: Superficial femoral artery (SFA) stenosis is a common type of peripheral arterial disease. Percutaneous treatment has similar long amputation rates with open surgery. There are various predictors of worse outcomes in this patient group, such as chronic kidney disease and malnutrition. The NAPLES score (NPS) is simple scoring system which consists of four elements. We aimed to investigate the role of NPS in predicting long-term mortality in patients with SFA stenosis who underwent a percutaneous intervention.

Methods: A total of 567 patients who underwent percutaneous treatment for stenosis of the SFA from January 2012 to December 2020 were enrolled. The primary endpoint was mortality, and the secondary endpoints were in-hospital thrombosis, restenosis, residual stenosis and postintervention complications. The patients were divided into two groups: high NPS (3, 4) and low NPS (0, 1, 2). Each group was evaluated in terms of clinical, laboratory and technical aspects.

Results: The patients with high NPS had a higher rate of mortality (34% vs. 16.3%, p < 0.05), and shorter time to (17.2 ± 14.7 vs. 29.2 ± 19.3 months, p < 0.05). In multivariate analysis, after adjusting for confounding factors, age [hazard ratio (HR): 1.049, 95% confidence interval (CI): 1.025-1.073, p < 0.001], chronic kidney disease (HR: 1.994, 95% CI: 1.347-2.951, p = 0.001), Rutherford class 5-6 (HR: 1.839, 95% CI: 1.195-2.830, p = 0.006), high C-reactive protein values (HR: 1.004, 95% CI: 1.001-1.008, p = 0.022), and estimated higher NPS (HR: 1.748, 95.5 CI: 1.189-2.572, p = 0.005) were shown to be independent risk factors of mortality.

Conclusions: NPS is a simple scoring system that can be used to predict long-term mortality in this group. More strict control of risk factors is required in patients with a high NPS.