Borges Wagner Ramos, Carvalho Aquiles Tadashi Ywata de, and Aras Junior Roque
Back Ground: Chronic critical ischemia of the lower limbs with the respective functional loss, continues to be a major public health problem, particularly in developing countries and patients with diabetes. Despite advances in diagnostic methods and innovations in endovascular treatment, amputation is still common, with great psychosocial impact. This study aims to identify possible predictors factors of major amputations in these patients. Materials and Methods: Prospective cohort study was conducted in which selected patients were submitted to clinical and laboratory evaluation, arterial imaging studies and defined study variables. Results: Between March 2015 and February 2016, 182 patients were selected. Of these, the affected limb was amputated in 66 and salvaged in 116. Amputations were more common among males (40.2%), smokers (37.2%), patients with high blood pressure (40.7%), and as a result of stroke (43.5%), without statistically significant difference. Factors associated with loss of limb were previous amputation (62%, p<0.001), trophic lesion (41.2%, p<0.018), infection (54.5%, p<0.001), chronic kidney disease (67.7%, p<0.001), elevated creatinine (3.64 ± 2.3, p<0.001), and hemoglobin A1C (7.79 ± 0.96 p<0.001), with statistical significance. Furthermore, in the group of amputees, the mean ages (73.5 ± 12.7, p=0.065), hemoglobin (9.7 ± 3.8, p=0.689), triglycerides (142.7 ± 55.4, p=0.233), and fasting glycemic level (247 ± 97, p=0.172), were higher, but without statistical significance. The nonamputee group had greater mean cholesterol HDL (50.9 ± 8.8, p=0.568), cholesterol LDL (150.9 ± 35.09 p=0.715), ankle–brachial index (0.14 ± 0.24; p=0.573), hospitalization time (13.9 ± 11.3, p=0.655), follow-up time (11.26 ± 4.09), and underwent more angioplasties and open revascularizations, but without statistical significance. The rate of limbs salvaged was 63.73%, deaths 9.89%, and follow-up loss 6.04%. The reduced model correctly classifies 90.7% of the cases with sensitivity of 86.4% and specificity of 93.1%. In the ROC, the area under the curve was 0.954 (p<0.001). Conclusion: Chronic kidney disease, ischemic heart disease, uncontrolled diabetes, arterial aneurysms, previous amputation and lack of preventive care are predictors of risk for major amputation in this population.
