Recognising anaemia and malnutrition in vascular patients with critical limb ischaemia.
BACKGROUND
Anaemia is a common problem in surgical patients. Patients with critical limb ischaemia (CLI) suffer chronic inflammation, repeated infection, require intervention, and can have a protracted hospital stay. The aims of this study were to assess anaemia and nutritional status in patients presenting with CLI.


METHODS
Two observational studies were undertaken, initially a retrospective series of 27 patients with CLI. Patient demographics, clinical details, transfusion status and in-patient laboratory haemoglobin values (Hb) were recorded. In a prospective series of 32 patients, laboratory markers to identify the cause for anaemia were assessed. Further nutritional status was assessed by records of height, weight, body mass index and a validated scoring system.


RESULTS
In the retrospective series, 15 patients (56%) were anaemic. Ten (37%) were transfused a median of 2 units (range, 2-13), a total of 35 units. Patients who were transfused had lower Hb on admission (P = 0.0019), most were anaemic on admission (90%). At discharge, most patients were anaemic (n = 23; 83%). In the prospective series of 32 patients, 20 (63%) were anaemic. Nutritional assessment was performed on 18, only seven patients were scored undernourished. This was increased to 23 by an independent assessor. Anaemia was associated with malnutrition (n = 17; P = 0.049) and an increased hospital stay (mean 25 days [SD 16] vs mean 12 days [SD 8], P = 0.0125; total 513 vs 144 bed days).


CONCLUSIONS
Anaemia and poor nutrition are common and not recognised in vascular patients presenting with critical limb ischaemia. Anaemia is associated with and increased length of hospital stay.
Medical School, University of Nottingham, Nottingham, UK. mital.shah@doctors.org.uk
M
M
Shah
A
A
Martin
B
B
Myers
S
S
MacSweeney
T
T
Richards
D000368:Aged; D000369:Aged, 80 and over; D000740:Anemia / Q000175:diagnosis / Q000209:etiology* / Q000628:therapy; D001803:Blood Transfusion; D004812:Epidemiologic Methods; D005121:Extremities / Q000098:blood supply*; D005260:Female; D006454:Hemoglobins / Q000378:metabolism; D006760:Hospitalization; D006801:Humans; D007511:Ischemia / Q000150:complications*; D007902:Length of Stay / Q000706:statistics & numerical data; D008297:Male; D044342:Malnutrition / Q000175:diagnosis / Q000209:etiology*; D008875:Middle Aged; D009752:Nutritional Status
D006454:Hemoglobins