Abstract 19345: Development and Validation of a New Scoring System for Predicting Wound Healing in Critical Limb Ischemia With Tissue Loss following Endovascular Therapy
Background: Wound healing is very important endpoint in critical limb ischemia (CLI) with tissue loss. The aim of this study was to design a scoring system for predicting wound healing in CLI patients who were treated with endovascular therapy (EVT) in consideration of various factors including patient background, intervention outcomes, and also wound characteristics.
Methods: Between April 2007 and October 2012, 184 patients (217 limbs) were treated with EVT for CLI with tissue loss in our institute. In these limbs, 236 individual wounds existed and were divided into a development group (n=118) and a validation group (n=118). Each variables which seem to be associated with wound healing were analyzed using the univariate Cox proportional hazards model. All variables tested in univariate analysis with p<0.25 were included in multivariate Cox hazards model. The scores for each variables were transformed from regression coefficients and computed in a total score.
Results: In multivariate Cox proportional hazard analysis, no direct blood flow to the wounds (HR 0.38, 95%CI 0.16-0.93, p=0.034), dependence on hemodialysis (HR 0.46, 95%CI 0.27-0.80, p=0.006), infectious wound (HR 0.54, 95%CI 0.30-0.99, p=0.044), heel wound (HR 0.38, 95%CI 0.16-0.91, p=0.029) and extensive wound extending onto the forefoot or midfoot along the dorsal or plantar surfaces (HR 0.09, 95%CI 0.02-0.39, p=0.001) were adverse predictors of wound healing. Each item’s score ranged from 0 to 4 and the total score ranged from 0 to 10. The area under the receiver operating characteristics curve revealed that there was 90.5% accuracy in the total scores predicting the likelihood of wound healing. In the development group, the wound healing rates at 12 months were 83% in low-risk group (scores≦2), 33% in moderate-risk group (scores 3-5), and 4.0% in high-risk group (scores≧6) (p<0.001). In the validation group, the corresponding wound healing rates were 80%, 49%, and 12%, respectively (p<0.001).
Conclusions: This new scoring system is useful for the risk stratification of wound healing in patients with CLI.
- © 2013 by American Heart Association, Inc.