Poor Nutritional Status Combined With Sarcopenia Were Associated With Increased Mortality and Amputation Rate in Patients With Lower Extremity Arterial Disease Following Endovascular Treatment.

Background: There is limited evidence assessing the prognostic impact of nutritional status and sarcopenia simultaneously in patients with lower extremity arterial disease (LEAD). In this study, we estimated nutritional status by determining the triglycerides, total cholesterol, and body weight index (TCBI) as well as sarcopenia by obtaining the computed tomography (CT)-based psoas muscle index (PMI) in LEAD patients. The aim of the study was to investigate the simultaneous prognostic impact of TCBI and PMI in LEAD patients.

Methods: Consecutive LEAD patients (n = 591) who underwent endovascular treatment (EVT) for the first time between 2009 and 2020 were enrolled. Primary and secondary outcome measures were all-cause mortality and major adverse cardiovascular and limb events (MACLE), respectively.

Results: Both indices were observed to be significantly lower in patients with chronic limb-threatening ischemia (CLTI) compared to those without (TCBI: 842.9 vs. 1016, p = 0.0014, PMI 3.142 vs. 3.532, p < 0.0001). Unadjusted Kaplan-Meier analyses revealed higher cumulative incidences of both outcome measures in patients with the lowest tertile of TCBI. Similar findings were observed in analyses regarding PMI. Moreover, multivariable Cox hazard analyses indicated the lowest tertile of both indices was significantly associated with increased risk of all-cause mortality (HR 6.41, 95% CI: 3.02-13.6, p < 0.0001) and MACLE (HR 2.73, 95% CI: 1.53-4.87, p = 0.0007) with the highest tertile of both indices as the reference.

Conclusion: This study showed a potential pathological link between poor nutritional status and advanced sarcopenia, which was associated with increased risk of poor prognosis in patients with LEAD following EVT.