title: Biochemical markers in patients with open reconstructions with peripheral arterial disease.
abstract: The purpose of our study was to determine outcome differences as a function of baseline high-sensitivity C-reactive protein (hsCRP) and B-type natriuretic peptide (BNP) levels in patients receiving lower extremity open reconstructions for the treatment of peripheral arterial occlusive disease. We retrospectively examined patients who underwent surgical reconstructions performed by a single operator during a seven-year time span who received preoperative hsCRP and BNP testing and post-procedure imaging. Outcomes of interest included major adverse limb events, a composite end point of target vessel revascularization, limb amputation, and disease progression, and major adverse cardiovascular events comprised of stroke, myocardial infarction, and death. A total of 89 limbs in 82 patients were included in analysis. Multivariate analysis demonstrated that higher hsCRP levels (>3.0 mg/L) trended toward, but failed to significantly associate with major adverse limb events at 24 months (hazard ratio: 2.2 [1.0-5.2], p = 0.06), however the use of a vein bypass conduit (vs. prosthetic reconstruction) significantly predicted major adverse limb events (hazard ratio: 3.2 [1.5-6.9], p < 0.01). Elevated BNP levels (>100 pg/ml), but not hsCRP, associated with major adverse cardiovascular events (hazard ratio: 3.5 [1.2-10.3], p = 0.03). Preoperative biochemical markers may assist in clinical decision making and stratifying patients regarding adverse events following open reconstructions.
authors.affiliation: Department of Surgery, Robert C. Byrd Health Sciences Center, West Virginia University, Charleston, WV, USA pstone0627@yahoo.com.
authors.forename: Patrick A
authors.initials: PA
authors.lastname: Stone
authors.affiliation: CAMC Health Education and Research Institute, Charleston, WV, USA.
authors.forename: Stephanie N
authors.initials: SN
authors.lastname: Thompson
authors.affiliation: Department of Surgery, Robert C. Byrd Health Sciences Center, West Virginia University, Charleston, WV, USA.
authors.forename: David
authors.initials: D
authors.lastname: Williams
authors.affiliation: Department of Surgery, Robert C. Byrd Health Sciences Center, West Virginia University, Charleston, WV, USA.
authors.forename: Zachary
authors.initials: Z
authors.lastname: AbuRahma
authors.affiliation: CAMC Health Education and Research Institute, Charleston, WV, USA.
authors.forename: Luke
authors.initials: L
authors.lastname: Grome
authors.affiliation: CAMC Health Education and Research Institute, Charleston, WV, USA.
authors.forename: Haley
authors.initials: H
authors.lastname: Schlarb
authors.affiliation: Department of Surgery, Robert C. Byrd Health Sciences Center, West Virginia University, Charleston, WV, USA.
authors.forename: Ali F
authors.initials: AF
authors.lastname: AbuRahma
mesh_terms: D000368:Aged; D000671:Amputation, Surgical; D015415:Biomarkers / Q000097:blood; D002097:C-Reactive Protein / Q000032:analysis*; D016009:Chi-Square Distribution; D003661:Decision Support Techniques; D018450:Disease Progression; D005260:Female; D006801:Humans; D053208:Kaplan-Meier Estimate; D023821:Limb Salvage; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D009203:Myocardial Infarction / Q000209:etiology; D020097:Natriuretic Peptide, Brain / Q000097:blood*; D018579:Patient Selection; D058729:Peripheral Arterial Disease / Q000097:blood / Q000000981:diagnostic imaging / Q000401:mortality / Q000601:surgery*; D011237:Predictive Value of Tests; D016016:Proportional Hazards Models; D019651:Plastic Surgery Procedures / Q000009:adverse effects / Q000401:mortality; D012086:Reoperation; D012189:Retrospective Studies; D018570:Risk Assessment; D012307:Risk Factors; D020521:Stroke / Q000209:etiology; D013997:Time Factors; D016896:Treatment Outcome; D015854:Up-Regulation; D014656:Vascular Surgical Procedures / Q000009:adverse effects / Q000401:mortality
chemical_list: D015415:Biomarkers; D020097:Natriuretic Peptide, Brain; D002097:C-Reactive Protein
keywords: B-type natriuretic peptide; High-sensitivity C-reactive protein; biomarkers; lower extremity reconstructions