[Relation of clinical and biochemical factors with clinical stage and type of surgery in a sample of patients with critical ischemia of limbs].
OBJECTIVE
The term of critical ischemia of legs is used in patients with chronic ischemia and pain in rest, ulcer or tisular necrosis secondary to oclussive arterial disease. The objective of our work was to identify factors related with clinical stage and type of surgery in these patients.


METHODS
An observational study was performed during two years, from january 1999 to december 2000, with 330 patients with surgery secondary to critical ischemia of legs. The next parameters were recorded during the Hospital stance; age, sex, blood pressure, glycaemia, total cholesterol, LDL cholesterol, HDL cholesterol, triglycerides, location of disease, type of surgery, arm-ankle index, and pharmacological treatment to cardiovascular risk factors. A regression logistic analyze was realized to study the influence of different variables in the clinical stage and in the type of surgery.


RESULTS
The mean age was 74.78+/-10.35 years, with a higher age in females (78.88+/-10.45 years) than males (73.70+/-10.07) (p<0,0001), with 261 males (79.1%) and 69 females (20.9%). Logistic regression model to investigate clinical stage III/IV (adjusted by age and sex) showed that the independent variables related with stage IV were diabetes mellitus, location of arterial lesion, and low cholesterol levels. A patient with diabetes mellitus type 2 has 3,322 (CI 95%: 1,881-5,866) times more risk of stage IV than a non diabetic patient. Odds ratio of total cholesterol was 0,990, the risk to develop a IV stage is increased 0,990 times for each mg/dl of cholesterol. Distal lesion increased the risk of stage IV en 6,897 times (CI 95%: 3,509-13,557). Logistic regression model to investigate type of surgery (amputation/bypass) (adjusted by age and sex) showed that diabetes mellitus type 2 had Odds Ratio (OR) of 3,37, this means that diabetes increase 3,37 times (CI 95%: 1,940-5,866) the risk of amputation. Total cholesterol showed a OR of 0,986, this jeans an increase of amputation 0,986 time with each mg/dl of cholesterol. Distal location increase risk of amputation 2,585 times. Patients with more than one surgery had an OR of 3,013 (1,602-5,666) to increase amputation. Each day of hospital stance increase 0,8% risk of amputation.


CONCLUSIONS
In multivariant análisis, diabetes mellitus, distal lesion, male sex and age over 75 years were positive related with stage IV, and cholesterol levels were inverse related. Diabetes mellitus, distal lesion, age over 75 years, days of hospital stance, number of surgeries were positive related with amputation as surgery technic and cholesterol levels were negative related.
Instituto de Endocrinología y Nutrición, Facultad de Medicina, Valladolid, Spain.
D A
DA
de Luis
H
H
Ovalle
J C
JC
Vaquero
E
E
Romero
D000368:Aged; D000369:Aged, 80 and over; D000671:Amputation, Surgical; D050197:Atherosclerosis / Q000503:physiopathology* / Q000601:surgery*; D005260:Female; D006801:Humans; D007511:Ischemia / Q000503:physiopathology* / Q000601:surgery*; D007866:Leg / Q000098:blood supply*; D008297:Male; D015999:Multivariate Analysis; D012307:Risk Factors