Glasgow prognostic score independently predicts amputation-free survival and wound healing in patients with chronic limb-threatening ischemia
J Nakamura, T Yamada, M Asai, T Morita, M Kawasaki, A Kikuchi, T Kondo, T Kawai, M Seo, T Fujita, Y Kokubu, M FukunamiAbstract
Background
The Glasgow prognostic score (GPS) is an inflammation and nutrition related score based on C-reactive protein and albumin concentrations. GPS has been reported to be associated with poor clinical outcome in patients with cancer. However, it remains to be clarified whether GPS could have prognostic impact in patients with chronic limb-threatening ischemia (CLTI).
Purpose
To evaluate whether GPS provide long-term prognostic information, such as amputation-free survival (AFS) and wound healing in patients with CLTI undergoing revascularization.
Methods
We retrospectively analyzed 161 consecutive patients with CLTI treated with revascularization. All participants underwent venous blood sampling and GPS was calculated at the endovascular therapy. GPS was defined using C-reactive protein >1.0 mg/dL and albumin <3.5 g/dL (0–2 points). Primary endpoint was 1-year AFS (death or major amputation within 365 days) and secondary endpoint was 1-year wound healing. GPS was analyzed as a continuous variable (per 1-point increase).
Results
At 1-year, the amputation-free survival (AFS) rate was 70%, and the wound healing rate was 58%. GPS was significantly higher in patients who experienced AFS events compared with those who did not (1.19 ± 0.13 vs. 0.86 ± 0.08, p = 0.025), Similarly, GPS was significantly lower in patients who achieved wound healing than in those who did not (0.791.14 ± 0.82 vs. 1.14 ± 0.80, p = 0.007). In multivariable Cox regression analysis, higher GPS was independently associated with reduced 1-year amputation-free survival (HR 1.72, 95% CI 1.16–2.60, p = 0.007) after adjustment for age, heart failure, coronary artery disease, and dialysis. Each 1-point increase in GPS was independently associated with reduced in 1-year wound healing (HR 0.75, 95% CI 0.58–0.98; p = 0.037), after adjustment for age, heart failure, and WIfI stage (≥3).
Conclusions
Glasgow Prognostic Score independently predicts amputation-free survival and wound healing in patients with CLTI. These findings suggest that systemic inflammatory–nutritional status influences limb outcomes beyond anatomical severity alone.KM curvesFor image description, please refer to the figure legend and surrounding text.