title: Acute and chronic anemia and short- and long-term outcome of patients with peripheral arterial disease and critical limb ischemia.
abstract: BACKGROUND
  Evident data about the additive effect of "the fifth cardiovascular risk factor" (anemia) and peripheral arterial disease (PAD) focused on morbidity and outcome of patients with PAD are currently still missing.
  
  
  RESULTS
  A total of 41,882 PAD patients were included. Of these, 5566 (13.3%) suffered from anemia. Patients with anemia were older (P<0.001), suffered more often from chronic kidney disease (P<0.001), coronary artery disease (P<0.001), and more severe PAD (P<0.001). However, they received significantly less endovascular revascularizations (P<0.001), had higher amputation rates (acute anemia: 3.7-fold, P<0.001; nutritional, aplastic, and anemia in chronic disease: 2.9-fold, P<0.001), higher in-hospital mortality rates (acute anemia: 6.4-fold, P<0.001; nutritional, aplastic, and anemia in chronic disease: 4.6-fold; P<0.001), had significantly higher in-hospital complications (P<0.001) compared to those without anemia. During a follow-up time up to 4years (until Dec. 31st, 2012, median 775days, 25th-75th percentiles 469-1120days) nutritional, aplastic, and anemia in chronic disease and acute anemia were high significant predictors of long-term mortality and amputation (each P<0.001). Lengths of hospital stay and reimbursement costs were higher (nutritional, aplastic, and anemia in chronic disease: 2-fold higher (P<0.001), acute anemia: 3-fold higher (P<0.001)) than in patients without anemia.
  
  
  CONCLUSIONS
  This study illustrates from a large, comprehensive database the association of acute, nutritional, aplastic, and anemia in chronic disease on morbidity, in-hospital treatment and complications, short- and long term outcome, and costs of patients with PAD.
authors.affiliation: Division of Vascular Medicine, Department of Cardiovascular Medicine, University Hospital Muenster, Muenster, Germany. Electronic address: florian.lueders@ukmuenster.de.
authors.forename: Florian
authors.initials: F
authors.lastname: Lüders
authors.affiliation: Division of Vascular Medicine, Department of Cardiovascular Medicine, University Hospital Muenster, Muenster, Germany. Electronic address: christianemaria.engelbertz@ukmuenster.de.
authors.forename: Christiane
authors.initials: C
authors.lastname: Engelbertz
authors.affiliation: Division of Vascular Medicine, Department of Cardiovascular Medicine, University Hospital Muenster, Muenster, Germany. Electronic address: meyborm@ukmuenster.de.
authors.forename: Matthias
authors.initials: M
authors.lastname: Meyborg
authors.affiliation: Division of Vascular Medicine, Department of Cardiovascular Medicine, University Hospital Muenster, Muenster, Germany. Electronic address: eva.freisinger@ukmuenster.de.
authors.forename: Eva
authors.initials: E
authors.lastname: Freisinger
authors.affiliation: Division of Vascular Medicine, Department of Cardiovascular Medicine, University Hospital Muenster, Muenster, Germany. Electronic address: mohammadnasser.malyar@ukmuenster.de.
authors.forename: Nasser M
authors.initials: NM
authors.lastname: Malyar
authors.affiliation: Department of Cardiovascular Medicine, University Hospital of Freiburg, Bad Krozingen, Germany. Electronic address: thomas.zeller@universitaets-herzzentrum.de.
authors.forename: Thomas
authors.initials: T
authors.lastname: Zeller
authors.affiliation: Division of Vascular Medicine, Department of Cardiovascular Medicine, University Hospital Muenster, Muenster, Germany. Electronic address: holger.reinecke@ukmuenster.de.
authors.forename: Holger
authors.initials: H
authors.lastname: Reinecke
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D000671:Amputation, Surgical / Q000706:statistics & numerical data*; D000740:Anemia / Q000453:epidemiology*; D003327:Coronary Disease / Q000453:epidemiology*; D005260:Female; D005500:Follow-Up Studies; D005858:Germany; D017052:Hospital Mortality; D006801:Humans; D007902:Length of Stay; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D058729:Peripheral Arterial Disease / Q000150:complications*; D016016:Proportional Hazards Models; D051436:Renal Insufficiency, Chronic / Q000453:epidemiology*; D012307:Risk Factors; D013997:Time Factors; D016896:Treatment Outcome
keywords: Anemia; Economic impact; Outcome; Peripheral arterial disease