Inflammatory biomarker-based risk prediction model for endovascular reconstruction in acute limb ischemia: A multicenter development and validation study.

Background: Inflammatory markers are associated with poor prognosis of peripheral vascular diseases. We aim to determine the relationship between inflammatory markers and the prognosis of acute lower limb ischemic disease and to construct and verify a prognostic model based on inflammatory indicators.

Methods: We evaluated 295 patients with a diagnosis of acute lower limb ischemia (ALI) from multiple centers between 2020 and 2023.The association between baseline disease characteristics with length of stay and half-year cut-off results were determined using SPSS software and R language, respectively. We identified predictive factors and built a nomogram to predict 30-day amputation rate in patients with ALI after endovascular surgery.

Results: In the training cohort, 34 patients underwent amputation within 30-day after endovascular surgery. Atrial fibrillation, diabetes, Rutherford grade IIb, higher neutrophil-to-lymphocyte ratio (NLR), higher platelet-to-lymphocyte ratio (PLR), lower hemoglobin (Hb), higher low-density lipoprotein (LDL), and higher triglycerides (TG) were independently associated with 30-day amputation. Pre-operative NLR, PLR and LDL presented a good discriminative ability (NLR: AUC=0.927; PLR: AUC=0.839; LDL: AUC=0.724). Five independent risk factors, diabetes, Rutherford grade, NLR, PLR, LDL, were screened from the results of the multivariate logistic analysis of the training cohort and included in the nomogram. The calibration curve also proved that the nomogram predicted outcomes were close to the ideal curve and the decision curve analysis (DCA) curve showed that all patients could benefit with threshold probability within 0-95%.

Conclusions: A nomogram for postoperative endovascular reconstruction of ALI was constructed with good predictive performance, which can be used as an auxiliary diagnosis of the potential risk factors and assist surgeon in making a personalized diagnosis and treatment for patients.