Reversion of the Inflammatory Markers in Patients With Chronic Limb-Threatening Ischemia.

Pedro Guimarães Cunha, Joana Ferreira, Isabel Vila, Cristina Silva, Cristina Cunha, Adhemar Longatto-Filho, Amílcar Mesquita, Jorge Cotter, Margarida Correia-Neves, Armando Mansilha, Susana Roque, Alexandre Lima Carneiro

Journal: Journal of the American Heart Association 2024;13(8):e031922

PMID: 38606780

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Abstract

BACKGROUND

Peripheral artery disease is characterized by an intense inflammatory process that can be associated with a higher mortality rate, particularly in chronic limb-threatening ischemia (CLTI). This study aims to compare the evolution of inflammatory markers between patients with claudication with those with CLTI at 3, 6, and 12 months.

METHODS AND RESULTS

An observational, single-center, and prospective study was conducted. A total of 119 patients with peripheral artery disease (65 with claudication and 54 with CLTI) were observed and inflammatory markers collected at admission and 3, 6, and 12 months. At admission, patients with CLTI, when compared with patients with claudication, had significantly higher serum levels of C-reactive protein and fibrinogen (positive acute-phase proteins) and lower serum level of albumin, total cholesterol, and high-density lipoprotein (negative acute-phase proteins): C-reactive protein (g/dL), 2.90 (25th-75th percentile, 2.90-4.90) versus 6.80 (25th-75th percentile, 2.90-53.26) (=0.000); fibrinogen (mg/dL), 293.00 (25th-75th percentile, 269.25-349.00) versus 415.50 (25th-75th percentile, 312.00-615.75) (=0.000); total cholesterol (mg/dL), 161.79±95% [152.74-170.85] versus 146.42%±95% [135.30-157.53] (=0.034); high-density lipoprotein (mg/dL), 50.00 (25th-75th percentile, 41.00-60.00) versus 37.00 (25th-75th percentile, 30.00-45.50) (=0.000); albumin (g/dL): 4.00 (25th-75th percentile, 3.70-4.20) versus 3.60 (25th-75th percentile, 3.10-4.00) (=0.003). The association between CLTI and total cholesterol was lost after adjusting for confounders. Three months after the resolution of the CLTI, there was an increase in the levels of negative acute-phase proteins and a decrease in positive acute-phase proteins. These inflammatory proteins did not register an evolution in patients with claudication. The differences in the inflammatory proteins between groups disappeared at 6 months.

CONCLUSIONS

CLTI has an inflammatory environment that can be partially reverted after resolution of the ischemic process, emphasizing the importance of timely intervention.

Address: Vascular Surgery Department-Physiology and Surgery Centro Hospitalar Universitário de São João Porto Portugal.; Life and Health Science Research Institute (ICVS), School of Medicine University of Minho Braga Portugal.; ICVS/3B's-PT Government Associated Laboratory Braga Portugal.; Academic Center Hospital da Senhora da Oliveira Guimarães Portugal.; Clinical Academic Center Hospital de Trás-os-Montes e Alto Douro-Professor Doutor Nuno Grande-CACTMAD Vila Real Portugal.; Life and Health Science Research Institute (ICVS), School of Medicine University of Minho Braga Portugal.; ICVS/3B's-PT Government Associated Laboratory Braga Portugal.; Radiology Department ULSAM Viana do Castelo Portugal.; Life and Health Science Research Institute (ICVS), School of Medicine University of Minho Braga Portugal.; ICVS/3B's-PT Government Associated Laboratory Braga Portugal.; Department of Pathology (LIM-14) University of São Paulo School of Medicine São Paulo Brazil.; Molecular Oncology Research Center Barretos Cancer Hospital Barretos São Paulo Brazil.; Academic Center Hospital da Senhora da Oliveira Guimarães Portugal.; Center for the Research and Treatment of Arterial Hypertension and Cardiovascular Risk, Hospital da Senhora da Oliveira Guimarães Portugal.; Internal Medicine Department Hospital da Senhora da Oliveira, Guimarães Braga Portugal.; Vascular Surgery Department-Hospital da Senhora da Oliveira Guimarães Portugal.; Life and Health Science Research Institute (ICVS), School of Medicine University of Minho Braga Portugal.; ICVS/3B's-PT Government Associated Laboratory Braga Portugal.; Academic Center Hospital da Senhora da Oliveira Guimarães Portugal.; Center for the Research and Treatment of Arterial Hypertension and Cardiovascular Risk, Hospital da Senhora da Oliveira Guimarães Portugal.; Internal Medicine Department Hospital da Senhora da Oliveira, Guimarães Braga Portugal.; Vascular Surgery Department-Physiology and Surgery Centro Hospitalar Universitário de São João Porto Portugal.; Department of Angiology and Vascular Surgery Centro Hospitalar Universitário de São João Porto Portugal.; Faculty of Medicine University of Porto Porto Portugal.

DOI: 10.1161/JAHA.123.031922

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MeSH Terms: Humans, Chronic Limb-Threatening Ischemia, C-Reactive Protein, Prospective Studies, Peripheral Arterial Disease, Intermittent Claudication, Ischemia, Fibrinogen, Lipoproteins, HDL, Cholesterol, Risk Factors, Treatment Outcome, Retrospective Studies, Limb Salvage, Chronic Disease