改善抑郁检测并测量其对慢性肢体威胁缺血（CLTI）短期生存的影响。

IF 1.4 4区医学 Q3 PERIPHERAL VASCULAR DISEASE

Annals of vascular surgery Pub Date : 2025-03-11 DOI:10.1016/j.avsg.2025.02.015

Cuneyt Koksoy, Ilse Torres Ruiz, Xin Yee Ooi, Zachary S. Pallister, Ramyar Gilani, Joseph L. Mills Sr., Jayer Chung

{"title":"改善抑郁检测并测量其对慢性肢体威胁缺血（CLTI）短期生存的影响。","authors":"Cuneyt Koksoy, Ilse Torres Ruiz, Xin Yee Ooi, Zachary S. Pallister, Ramyar Gilani, Joseph L. Mills Sr., Jayer Chung","doi":"10.1016/j.avsg.2025.02.015","DOIUrl":null,"url":null,"abstract":"<div><h3>Background</h3><div>Depression is underdiagnosed in chronic limb-threatening ischemia (CLTI) patients, and its impact on outcomes is unclear. This study aims to evaluate a CLTI-specific questionnaire designed to detect depression and anxiety, as well as to quantify its impact on early outcomes.</div></div><div><h3>Methods</h3><div>A serial cross-sectional study was conducted over the following 2 4-month periods: block I, which retrospectively examined depression prevalence based on medical records, and block II, which prospectively assessed depression using a CLTI-specific questionnaire. Patients were followed for 6 months to assess early outcomes. Data on demographics; comorbidities; wound, ischemia, foot infection (WIfI) grades; perioperative and 6-month limb salvage; and survival were collected and analyzed.</div></div><div><h3>Results</h3><div>We evaluated 101 CLTI patients (58 in block I; 43 in block II; median age 68 years [interquartile range 62–74]; 67 [66.3%] male). In block I and block II, 20.7% and 23.3% (<em>P</em> = 0.76), respectively, had a prior depression diagnosis. The CLTI-specific questionnaire in block II showed a median depression score of 22 (interquartile range 19–33), identifying 32.6% with moderate/severe depression and 11.9% more patients compared to chart review alone. Active smoking (hazard ratio 5.16, 95% confidence interval 1.9–14.1) and WIfI clinical stage 4 (hazard ratio 4.69, 95% confidence interval 1.39–15.75) were significantly associated with depression. At 6 months, patients with depression had higher rates of major amputation (18.2% vs. 4.0%; <em>P</em> = 0.02) and mortality (27.3% vs. 6.3%; <em>P</em> < 0.01).</div></div><div><h3>Conclusions</h3><div>The overall prevalence of depression in CLTI patients is 32.6%. Our novel CLTI-specific questionnaire detects 12% more cases of moderate/severe depression compared to chart review alone. Depression was linked to higher 6-month mortality, though confounders like smoking and WIfI stage 4 may contribute. Identifying and treating depression in high-risk CLTI patients could improve outcomes.</div></div>","PeriodicalId":8061,"journal":{"name":"Annals of vascular surgery","volume":"115 ","pages":"Pages 185-196"},"PeriodicalIF":1.4000,"publicationDate":"2025-03-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":"{\"title\":\"Improving Depression Detection and Measuring Its Impact upon Short-Term Survival in Chronic Limb-Threatening Ischemia\",\"authors\":\"Cuneyt Koksoy, Ilse Torres Ruiz, Xin Yee Ooi, Zachary S. Pallister, Ramyar Gilani, Joseph L. Mills Sr., Jayer Chung\",\"doi\":\"10.1016/j.avsg.2025.02.015\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<div><h3>Background</h3><div>Depression is underdiagnosed in chronic limb-threatening ischemia (CLTI) patients, and its impact on outcomes is unclear. This study aims to evaluate a CLTI-specific questionnaire designed to detect depression and anxiety, as well as to quantify its impact on early outcomes.</div></div><div><h3>Methods</h3><div>A serial cross-sectional study was conducted over the following 2 4-month periods: block I, which retrospectively examined depression prevalence based on medical records, and block II, which prospectively assessed depression using a CLTI-specific questionnaire. Patients were followed for 6 months to assess early outcomes. Data on demographics; comorbidities; wound, ischemia, foot infection (WIfI) grades; perioperative and 6-month limb salvage; and survival were collected and analyzed.</div></div><div><h3>Results</h3><div>We evaluated 101 CLTI patients (58 in block I; 43 in block II; median age 68 years [interquartile range 62–74]; 67 [66.3%] male). In block I and block II, 20.7% and 23.3% (<em>P</em> = 0.76), respectively, had a prior depression diagnosis. The CLTI-specific questionnaire in block II showed a median depression score of 22 (interquartile range 19–33), identifying 32.6% with moderate/severe depression and 11.9% more patients compared to chart review alone. Active smoking (hazard ratio 5.16, 95% confidence interval 1.9–14.1) and WIfI clinical stage 4 (hazard ratio 4.69, 95% confidence interval 1.39–15.75) were significantly associated with depression. At 6 months, patients with depression had higher rates of major amputation (18.2% vs. 4.0%; <em>P</em> = 0.02) and mortality (27.3% vs. 6.3%; <em>P</em> < 0.01).</div></div><div><h3>Conclusions</h3><div>The overall prevalence of depression in CLTI patients is 32.6%. Our novel CLTI-specific questionnaire detects 12% more cases of moderate/severe depression compared to chart review alone. Depression was linked to higher 6-month mortality, though confounders like smoking and WIfI stage 4 may contribute. Identifying and treating depression in high-risk CLTI patients could improve outcomes.</div></div>\",\"PeriodicalId\":8061,\"journal\":{\"name\":\"Annals of vascular surgery\",\"volume\":\"115 \",\"pages\":\"Pages 185-196\"},\"PeriodicalIF\":1.4000,\"publicationDate\":\"2025-03-11\",\"publicationTypes\":\"Journal Article\",\"fieldsOfStudy\":null,\"isOpenAccess\":false,\"openAccessPdf\":\"\",\"citationCount\":\"0\",\"resultStr\":null,\"platform\":\"Semanticscholar\",\"paperid\":null,\"PeriodicalName\":\"Annals of vascular surgery\",\"FirstCategoryId\":\"3\",\"ListUrlMain\":\"https://www.sciencedirect.com/science/article/pii/S0890509625001177\",\"RegionNum\":4,\"RegionCategory\":\"医学\",\"ArticlePicture\":[],\"TitleCN\":null,\"AbstractTextCN\":null,\"PMCID\":null,\"EPubDate\":\"\",\"PubModel\":\"\",\"JCR\":\"Q3\",\"JCRName\":\"PERIPHERAL VASCULAR DISEASE\",\"Score\":null,\"Total\":0}","platform":"Semanticscholar","paperid":null,"PeriodicalName":"Annals of vascular surgery","FirstCategoryId":"3","ListUrlMain":"https://www.sciencedirect.com/science/article/pii/S0890509625001177","RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q3","JCRName":"PERIPHERAL VASCULAR DISEASE","Score":null,"Total":0}

引用次数: 0

摘要

背景：慢性肢体威胁缺血（CLTI）患者的抑郁症诊断不足，其对预后的影响尚不清楚。本研究旨在评估一份专门用于检测抑郁和焦虑的clti问卷，并量化其对早期预后的影响。方法：在两个为期4个月的时间段内进行了一系列横断面研究：第一部分，根据医疗记录回顾性检查抑郁症的患病率，第二部分，使用clti特异性问卷前瞻性评估抑郁症。对患者进行为期6个月的随访，以评估早期结果。收集和分析人口统计学、合并症、伤口、缺血、足部感染（WIfI）等级、围手术期和六个月肢体保留以及生存数据。结果：我们评估了101例CLTI患者(58例为Block I；第II区43人；中位年龄68岁[IQR 62-74]；67[66.3%]男性)。在第一组中，20.7%的人有抑郁症病史；Block II为23.3% （p=0.76）。Block II的clti特异性问卷显示，抑郁评分中位数为22 (IQR 19-33)，识别出32.6%的中度/重度抑郁症患者，与单独的图表复习相比，多出11.9%。积极吸烟（危险比[HR] 5.16, 95%可信区间[CI] 1.9-14.1）和WIfI临床4期（危险比[HR] 4.69, 95%可信区间[CI] 1.39-15.75）与抑郁症显著相关。在6个月时，抑郁症患者的主要截肢率更高(18.2%比4.0%；P =0.02)和死亡率(27.3% vs. 6.3%；结论：CLTI患者抑郁总体患病率为32.6%。与单独的图表回顾相比，我们新颖的clti特异性问卷检测到的中度/重度抑郁症病例增加了12%。抑郁症与较高的六个月死亡率有关，尽管吸烟和WIfI第四阶段等混杂因素可能有所贡献。识别和治疗高危CLTI患者的抑郁症可以改善预后。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

查看原文本刊更多论文

Improving Depression Detection and Measuring Its Impact upon Short-Term Survival in Chronic Limb-Threatening Ischemia

Background

Depression is underdiagnosed in chronic limb-threatening ischemia (CLTI) patients, and its impact on outcomes is unclear. This study aims to evaluate a CLTI-specific questionnaire designed to detect depression and anxiety, as well as to quantify its impact on early outcomes.

Methods

A serial cross-sectional study was conducted over the following 2 4-month periods: block I, which retrospectively examined depression prevalence based on medical records, and block II, which prospectively assessed depression using a CLTI-specific questionnaire. Patients were followed for 6 months to assess early outcomes. Data on demographics; comorbidities; wound, ischemia, foot infection (WIfI) grades; perioperative and 6-month limb salvage; and survival were collected and analyzed.

Results

We evaluated 101 CLTI patients (58 in block I; 43 in block II; median age 68 years [interquartile range 62–74]; 67 [66.3%] male). In block I and block II, 20.7% and 23.3% (P = 0.76), respectively, had a prior depression diagnosis. The CLTI-specific questionnaire in block II showed a median depression score of 22 (interquartile range 19–33), identifying 32.6% with moderate/severe depression and 11.9% more patients compared to chart review alone. Active smoking (hazard ratio 5.16, 95% confidence interval 1.9–14.1) and WIfI clinical stage 4 (hazard ratio 4.69, 95% confidence interval 1.39–15.75) were significantly associated with depression. At 6 months, patients with depression had higher rates of major amputation (18.2% vs. 4.0%; P = 0.02) and mortality (27.3% vs. 6.3%; P < 0.01).

Conclusions

The overall prevalence of depression in CLTI patients is 32.6%. Our novel CLTI-specific questionnaire detects 12% more cases of moderate/severe depression compared to chart review alone. Depression was linked to higher 6-month mortality, though confounders like smoking and WIfI stage 4 may contribute. Identifying and treating depression in high-risk CLTI patients could improve outcomes.

求助全文

通过发布文献求助，成功后即可免费获取论文全文。去求助

来源期刊

Annals of vascular surgery 医学-外科

CiteScore

3.00

自引率

13.30%

发文量

603

审稿时长

50 days

期刊介绍： Annals of Vascular Surgery, published eight times a year, invites original manuscripts reporting clinical and experimental work in vascular surgery for peer review. Articles may be submitted for the following sections of the journal: Clinical Research (reports of clinical series, new drug or medical device trials) Basic Science Research (new investigations, experimental work) Case Reports (reports on a limited series of patients) General Reviews (scholarly review of the existing literature on a relevant topic) Developments in Endovascular and Endoscopic Surgery Selected Techniques (technical maneuvers) Historical Notes (interesting vignettes from the early days of vascular surgery) Editorials/Correspondence