title: Development and validation of a new scoring system to predict wound healing after endovascular therapy in critical limb ischemia with tissue loss.
abstract: OBJECTIVE
  To develop a scoring system to predict wound healing in critical limb ischemia (CLI) patients treated with endovascular therapy (EVT).
  
  
  METHODS
  Between July 2007 and January 2013, 184 patients (118 men; mean age 73.0 years) with CLI (217 limbs) and tissue loss underwent EVT. From this cohort 236 separate wounds were divided into development (n = 118) and validation (n = 118) groups. Predictors of wound healing were identified using multivariable analysis. Each predictor was assigned a score based on its regression coefficient, and total scores were calculated, ranging from 0 to 1 for low risk up to ≥ 4 for high risk of a nonhealing wound. The performance of the scoring system in the prediction of wound healing was evaluated by calculating the area under the receiver operating characteristics (ROC) curve.
  
  
  RESULTS
  By multivariable analysis, a University of Texas grade ≥ 2 (HR 0.524, 95% CI 0.288-0.951, p = 0.034), an infected wound (HR 0.497, 95% CI 0.276-0.894, p = 0.020), dependence on hemodialysis (HR 0.459, 95% CI 0.259-0.814, p = 0.008), no visible blood flow to the wound (HR 0.343, 95% CI 0.146-0.802, p = 0.014), and major tissue loss (HR 0.322, 95% CI 0.165-0.630, p = 0.001) predicted a non-healing wound. The 1-year rates of wound healing in the low-, intermediate-, and high-risk groups were 94.6%, 67.6%, and 9.1%, respectively, in the development group (p < 0.001) and 92.3%, 70.5%, and 31.3%, respectively, in the validation sample (p < 0.001). The area under the ROC curve was 0.922 in the development group and 0.808 in the validation sample.
  
  
  CONCLUSIONS
  This scoring system reliably predicts wound healing in CLI patients after endovascular revascularization and is potentially helpful in deciding if additional adjuncts or revascularization should be considered.
authors.affiliation: Saiseikai Yokohama City Eastern Hospital, Yokohama, Japan ovation17@gmail.com.
authors.forename: Norihiro
authors.initials: N
authors.lastname: Kobayashi
authors.affiliation: Saiseikai Yokohama City Eastern Hospital, Yokohama, Japan.
authors.forename: Keisuke
authors.initials: K
authors.lastname: Hirano
authors.affiliation: Saiseikai Yokohama City Eastern Hospital, Yokohama, Japan.
authors.forename: Masatsugu
authors.initials: M
authors.lastname: Nakano
authors.affiliation: Saiseikai Yokohama City Eastern Hospital, Yokohama, Japan.
authors.forename: Toshiya
authors.initials: T
authors.lastname: Muramatsu
authors.affiliation: Saiseikai Yokohama City Eastern Hospital, Yokohama, Japan.
authors.forename: Reiko
authors.initials: R
authors.lastname: Tsukahara
authors.affiliation: Saiseikai Yokohama City Eastern Hospital, Yokohama, Japan.
authors.forename: Yoshiaki
authors.initials: Y
authors.lastname: Ito
authors.affiliation: Saiseikai Yokohama City Eastern Hospital, Yokohama, Japan.
authors.forename: Hiroshi
authors.initials: H
authors.lastname: Ishimori
authors.affiliation: Saiseikai Yokohama City Eastern Hospital, Yokohama, Japan.
authors.forename: Masahiro
authors.initials: M
authors.lastname: Yamawaki
authors.affiliation: Saiseikai Yokohama City Eastern Hospital, Yokohama, Japan.
authors.forename: Motoharu
authors.initials: M
authors.lastname: Araki
authors.affiliation: Saiseikai Yokohama City Eastern Hospital, Yokohama, Japan.
authors.forename: Hideyuki
authors.initials: H
authors.lastname: Takimura
authors.affiliation: Saiseikai Yokohama City Eastern Hospital, Yokohama, Japan.
authors.forename: Yasunari
authors.initials: Y
authors.lastname: Sakamoto
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D015992:Body Mass Index; D057510:Endovascular Procedures / Q000379:methods; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007511:Ischemia / Q000628:therapy*; D023821:Limb Salvage; D035002:Lower Extremity / Q000098:blood supply*; D008297:Male; D008875:Middle Aged; D058729:Peripheral Arterial Disease / Q000401:mortality / Q000473:pathology* / Q000628:therapy*; D011237:Predictive Value of Tests; D015203:Reproducibility of Results; D012189:Retrospective Studies; D018570:Risk Assessment; D012307:Risk Factors; D012720:Severity of Illness Index; D016019:Survival Analysis; D016896:Treatment Outcome; D014945:Wound Healing
keywords: critical limb ischemia; endovascular therapy; peripheral artery disease; scoring system; tissue loss; wound healing; wound infection