title: Anemia, an independent predictive factor for amputation and mortality in patients hospitalized for peripheral artery disease.
abstract: OBJECTIVE
  Anemia is associated with poorer outcome in coronary artery disease (CAD) and heart failure (HF), but data on patients with peripheral artery disease (PAD) are scarce, especially regarding the local (limb) prognosis. It was hypothesized that anemia is associated with poorer prognosis in patients hospitalized for PAD, and this relationship would be proportional to the severity of the anemia.
  
  
  METHODS
  Prospective cohort study.
  
  
  METHODS
  The Cohorte des Patients Artéritiques (COPART) is a multicenter registry of patients hospitalized for PAD in three university hospitals in southwestern France.
  
  
  METHODS
  Clinical and biological data were collected at entry. Patients were followed up to 1 year. Anemia was defined by Hb < 8.2 mmol/L in men and <7.6 mmol/L in women. The primary outcome was 1-year survival free from major amputation. The secondary outcome was 1-year major amputation.
  
  
  RESULTS
  Data of 925 consecutive patients (70.7 ± 12.8 years, 29.2% females) were analyzed. Patients were hospitalized either for revascularization or medical therapy, with Rutherford categories 3 (25%), 4 (9.1%), 5 or 6 (55.1%) as well as acute limb ischemia (10.8%). Anemia was present in 471 patients (50.9%). These patients were significantly older, with higher rates of hypertension, diabetes, clinical CAD, HF, chronic kidney disease, and cancer, and with lower rates of smoking and dyslipidemia than their counterparts (p < .05 for all). In multivariate models, anemia was significantly and independently associated (p < 0.001) with death and amputation (HR 1.44; 95% CI 1.15-1.80) with similar findings for secondary outcomes. A lower level of hemoglobin is associated with a higher risk of mortality and amputation (HR 1.20; 95% CI 1.09-1.32).
  
  
  CONCLUSIONS
  Anemia and its severity are independent predictors of mortality and limb loss in patients hospitalized for PAD.
authors.affiliation: Department of Thoracic and Cardiovascular Surgery and Angiology, Dupuytren University Hospital, Limoges, France; INSERM U1094, Tropical Neuroepidemiology, Limoges, France; CNRS FR 3503 GEIST, Limoges, France. Electronic address: ileana.desormais@orange.fr.
authors.forename: I
authors.initials: I
authors.lastname: Desormais
authors.affiliation: INSERM U1094, Tropical Neuroepidemiology, Limoges, France; CNRS FR 3503 GEIST, Limoges, France; Department of Cardiology, Dupuytren University Hospital, Limoges, France.
authors.forename: V
authors.initials: V
authors.lastname: Aboyans
authors.affiliation: Department of Vascular Medicine, Rangueil Hospital, Toulouse, France; INSERM U858, Toulouse, France.
authors.forename: A
authors.initials: A
authors.lastname: Bura
authors.affiliation: Department of Vascular Medicine, Saint Andre Hospital, Bordeaux, France.
authors.forename: J
authors.initials: J
authors.lastname: Constans
authors.affiliation: Department of Vascular Medicine, Rangueil Hospital, Toulouse, France; INSERM U858, Toulouse, France.
authors.forename: J-P
authors.initials: JP
authors.lastname: Cambou
authors.affiliation: Department of Vascular Medicine, HEGP, Paris, France.
authors.forename: E
authors.initials: E
authors.lastname: Messas
authors.affiliation: INSERM U1094, Tropical Neuroepidemiology, Limoges, France; CNRS FR 3503 GEIST, Limoges, France.
authors.forename: A
authors.initials: A
authors.lastname: Labrunie
authors.affiliation: Department of Thoracic and Cardiovascular Surgery and Angiology, Dupuytren University Hospital, Limoges, France; INSERM U1094, Tropical Neuroepidemiology, Limoges, France; CNRS FR 3503 GEIST, Limoges, France.
authors.forename: P
authors.initials: P
authors.lastname: Lacroix
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D000671:Amputation, Surgical / Q000009:adverse effects / Q000401:mortality; D000740:Anemia / Q000097:blood / Q000150:complications / Q000175:diagnosis / Q000401:mortality*; D015415:Biomarkers / Q000097:blood; D018572:Disease-Free Survival; D005260:Female; D005602:France / Q000453:epidemiology; D006454:Hemoglobins / Q000378:metabolism; D006760:Hospitalization; D006785:Hospitals, University; D006801:Humans; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged; D058729:Peripheral Arterial Disease / Q000150:complications / Q000175:diagnosis / Q000401:mortality / Q000601:surgery*; D016016:Proportional Hazards Models; D011446:Prospective Studies; D012042:Registries; D012307:Risk Factors; D012720:Severity of Illness Index; D013997:Time Factors; D016896:Treatment Outcome
chemical_list: D015415:Biomarkers; D006454:Hemoglobins
keywords: Anemia; Major amputation; Mortality; Peripheral artery disease