title: Factors Affecting Mortality After Major Nontraumatic Lower Extremity Amputation.
abstract: Our aim was to evaluate the factors affecting the mortality of patients who underwent nontraumatic major lower limb amputation due to ischemic and/or diabetic causes. A total of 100 patients were included in the study. Among these patients, 70 (70%) underwent below-knee amputation, whereas 30 (30%) underwent above-knee amputation. Eleven (15.7%) of the 70 patients who underwent below-knee amputation and 12 (40%) of the 30 patients who underwent above-knee amputation (P = .008) were deceased. After multivariable Poisson regression analysis, female gender (risk ratio [RR] = 2.00, 95% CI = 1.07-3.74) and a neutrophil lymphocyte ratio (NLR) less than 6.8 (RR = 5.12, 95% CI = 1.86-14.08) were found to be independent risk factors for mortality. The value of 6.8 was used as a cutoff point for the NLR (area under the curve = 0.73, 95% CI = 0.62-0.85), with a sensitivity, specificity, positive predictive value, and negative predictive value of 83%, 66%, 57%, and 92%, respectively. The NLR and female gender were found to be independent factors that are related to increased mortality in patients who underwent lower limb amputation due to diabetic and/or ischemic causes. The coexistence of congestive heart failure and the amputation level (above knee) were found to be predictors of mortality in univariable analysis, but significance could not be demonstrated in multivariable analysis.
authors.affiliation: Department of General Surgery, Ankara Numune Training and Research Hospital, Ankara, Turkey.
authors.forename: Tolga
authors.initials: T
authors.lastname: Dinc
authors.affiliation: Department of General Surgery, Ankara Numune Training and Research Hospital, Ankara, Turkey.
authors.forename: Arife
authors.initials: A
authors.lastname: Polat Duzgun
authors.affiliation: Department of General Surgery, Ankara Numune Training and Research Hospital, Ankara, Turkey.
authors.forename: Selami Ilgaz
authors.initials: SI
authors.lastname: Kayilioglu
authors.affiliation: Department of General Surgery, Ankara Numune Training and Research Hospital, Ankara, Turkey.
authors.forename: Ahmet
authors.initials: A
authors.lastname: Erdogan
authors.affiliation: Department of Biostatistics, Ankara University School of Medicine, Ankara, Turkey.
authors.forename: Zeynep
authors.initials: Z
authors.lastname: Yavuz
authors.affiliation: Department of General Surgery, Ankara Numune Training and Research Hospital, Ankara, Turkey farukcoskun@mynet.com.
authors.forename: Faruk
authors.initials: F
authors.lastname: Coskun
mesh_terms: D000368:Aged; D000671:Amputation, Surgical / Q000379:methods / Q000401:mortality; D001772:Blood Cell Count / Q000379:methods / Q000706:statistics & numerical data; D005260:Female; D006801:Humans; D007511:Ischemia / Q000150:complications / Q000175:diagnosis; D007871:Leg Ulcer / Q000097:blood / Q000209:etiology / Q000401:mortality / Q000601:surgery; D035002:Lower Extremity / Q000473:pathology / Q000601:surgery; D008214:Lymphocytes; D008297:Male; D008875:Middle Aged; D009504:Neutrophils; D011237:Predictive Value of Tests; D016016:Proportional Hazards Models; D012189:Retrospective Studies; D018570:Risk Assessment; D012737:Sex Factors; D014421:Turkey / Q000453:epidemiology
keywords: amputation; gender; lower extremity; mortality; neutrophils