title: Mortality rates and mortality predictors in patients with symptomatic peripheral artery disease stratified according to age and diabetes.
abstract: OBJECTIVE
  Atherosclerotic peripheral arterial disease (PAD) is one of the most prevalent, morbid, and mortal diseases. The aim of this study was to evaluate mortality rates of patients with atherosclerotic PAD stratified according to age and diabetes and to determine predictors of death.
  
  
  METHODS
  We studied 487 patients with symptomatic PAD consecutively admitted to the hospital. This cohort included the following four patient subgroups: (1) 216 patients with PAD <75 years of age without diabetes mellitus; (2) 115 patients with PAD < 75 years of age with diabetes mellitus; (3) 102 patients with PAD ≥ 75 years of age without diabetes mellitus; and (4) 54 patients with PAD ≥ 75 years of age with diabetes mellitus. Control subjects without atherosclerotic disease were matched to the patients with PAD in a 1:1 design by sex, age (± 2 years), and diabetes mellitus status. Outcome measure was all-cause mortality at 5 years.
  
  
  RESULTS
  Mortality rates at 5 years were 10% in nondiabetic patients with PAD < 75 years of age (vs 5% in control subjects; risk ratio [RR], 2.15; 95% confidence interval [CI], 1.60-4.34); 23% in diabetic patients with PAD < 75 years of age (vs 7% in control subjects; RR, 3.53; 95% CI, 1.80-6.91); 38% in nondiabetic patients with PAD ≥ 75 years of age (vs 22% in control subjects; RR, 2.08; 95% CI, 1.26-3.44); and 52% in diabetic patients with PAD ≥ 75 years of age. Applying multivariate Cox proportional hazards regression analyses (with cardiovascular risk factors, coexisting atherosclerotic disease, clinical stage of PAD, and several biochemical markers as predictor variables), we found the following independent predictors of outcome: in the 216 nondiabetic patients with PAD < 75 years of age, high-sensitivity C-reactive protein (hs-CRP) (RR, 3.04; 95% CI, 1.48-6.26); in the 115 diabetic patients with PAD < 75 years of age, amino-terminal pro-B-type natriuretic peptide (NT-proBNP) (RR, 2.63; 95% CI, 1.65-4.19); in the 102 nondiabetic patients with PAD ≥ 75 years of age, critical limb ischemia (RR, 3.70; 95% CI, 1.82-7.52) and NT-proBNP (RR, 1.93; 95% CI, 1.32-2.82); and in the 54 diabetic patients with PAD ≥ 75 years of age, hs-CRP (RR, 2.61; 95% CI, 1.45-4.67) and NT-proBNP (RR, 3.31; 95% CI, 1.96-5.60).
  
  
  CONCLUSIONS
  Mortality rates at 5 years varied considerably among patients with PAD stratified according to age and diabetes. Predictors of death differed among the four patient subgroups in this study and included critical limb ischemia, hs-CRP, and NT-proBNP. Our results might help to develop future strategies for optimized treatment of hospitalized patients with symptomatic PAD.
authors.affiliation: Department of Laboratory Medicine, Konventhospital Barmherzige Brueder, Linz, Austria. Electronic address: thomas.mueller@bs-lab.at.
authors.forename: Thomas
authors.initials: T
authors.lastname: Mueller
authors.affiliation: Department of Vascular Surgery, Konventhospital Barmherzige Brueder, Linz, Austria.
authors.forename: Franz
authors.initials: F
authors.lastname: Hinterreiter
authors.affiliation: Department of Radiology, Konventhospital Barmherzige Brueder, Linz, Austria.
authors.forename: Christian
authors.initials: C
authors.lastname: Luft
authors.affiliation: Institute for Applied System Sciences and Statistics, University of Linz, Linz, Austria.
authors.forename: Werner
authors.initials: W
authors.lastname: Poelz
authors.affiliation: Department of Laboratory Medicine, Konventhospital Barmherzige Brueder, Linz, Austria.
authors.forename: Meinhard
authors.initials: M
authors.lastname: Haltmayer
authors.affiliation: Department of Laboratory Medicine, Konventhospital Barmherzige Brueder, Linz, Austria.
authors.forename: Benjamin
authors.initials: B
authors.lastname: Dieplinger
mesh_terms: D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D001317:Austria / Q000453:epidemiology; D015415:Biomarkers / Q000097:blood; D002097:C-Reactive Protein / Q000032:analysis; D016022:Case-Control Studies; D015897:Comorbidity; D016638:Critical Illness; D003920:Diabetes Mellitus / Q000097:blood / Q000175:diagnosis / Q000401:mortality*; D005260:Female; D006801:Humans; D007511:Ischemia / Q000401:mortality; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged; D009026:Mortality / Q000639:trends; D015999:Multivariate Analysis; D020097:Natriuretic Peptide, Brain / Q000097:blood; D016017:Odds Ratio; D010343:Patient Admission; D010446:Peptide Fragments / Q000097:blood; D058729:Peripheral Arterial Disease / Q000097:blood / Q000175:diagnosis / Q000401:mortality*; D016016:Proportional Hazards Models; D011446:Prospective Studies; D012307:Risk Factors; D013997:Time Factors
chemical_list: D015415:Biomarkers; D010446:Peptide Fragments; C109794:pro-brain natriuretic peptide (1-76); D020097:Natriuretic Peptide, Brain; D002097:C-Reactive Protein