Recognising anaemia and malnutrition in vascular patients with critical limb ischaemia

Abstract

INTRODUCTION Anaemia is a common problem in surgical patients. Patients with critical limb ischaemia (CLI) suffer chronic inflammation, repeated infection, require intervention, and can have a protracted hospital stay. The aims of this study were to assess anaemia and nutritional status in patients presenting with CLI. PATIENTS AND METHODS Two observational studies were undertaken, initially a retrospective series of 27 patients with CLI. Patient demographics, clinical details, transfusion status and in-patient laboratory haemoglobin values (Hb) were recorded. In a prospective series of 32 patients, laboratory markers to identify the cause for anaemia were assessed. Further nutritional status was assessed by records of height, weight, body mass index and a validated scoring system. RESULTS In the retrospective series, 15 patients (56%) were anaemic. Ten (37%) were transfused a median of 2 units (range, 2-13), a total of 35 units. Patients who were transfused had lower Hb on admission (P = 0.0019), most were anaemic on admission (90%). At discharge, most patients were anaemic (n = 23; 83%). In the prospective series of 32 patients, 20 (63%) were anaemic. Nutritional assessment was performed on 18, only seven patients were scored undernourished. This was increased to 23 by an independent assessor. Anaemia was associated with malnutrition (n = 17; P = 0.049) and an increased hospital stay (mean 25 days [SD 16] vs mean 12 days [SD 8], P = 0.0125; total 513 vs 144 bed days). CONCLUSIONS Anaemia and poor nutrition are common and not recognised in vascular patients presenting with critical limb ischaemia. Anaemia is associated with and increased length of hospital stay.

Pre-Operative Anaemia Predicts Poor Outcomes in Patients Undergoing Infra-Inguinal Bypass Surgery

“…Fifty three percent of our patients with CLI had anaemia on admission. This is in line with a study published by Shah M. et al who found that 56% of patients admitted to a tertiary hospital in the United Kingdom for CLI had anaemia [2]. Most of our patients with anaemia as a comorbidity on admission had only mild anaemia (mean 113 g/L ±SD 14).…”

“…It may also impair other vital organ functions and the immune response resulting in increased mortality. Musallam et al recently described mild anaemia as an independent predictor of increased thirty days morbidity and mortality in a large cohort of patients undergoing major non-cardiac surgery [2]. The unadjusted mortality rate in patients who had any degree of anaemia was six times that of those who did not have pre-operative anaemia [2].…”

“…In a cross sectional study from Sweden, the prevalence of PAD and CLI increases with age, and up to 3.3% of the population aged 80 -84 years old has CLI [1]. Many CLI patients are current or ex-smokers and suffer from multiple medical comorbidities including malignancies, diabetes, impaired renal function and poor nutrition, placing them at a high risk for developing anaemia of chronic disease [2]. Diabetes, renal impairment and smoking are recognized as independent risk factors for poor surgical outcomes [3]- [5].…”

Post-treatment neutrophil-lymphocyte ratio independently predicts amputation in critical limb ischemia without operation

“…The post-NLR was identified as an independent predictive factor of amputation in CLI patients who did not undergo surgery. CLI patients usually suffer from malnutrition ( 20 ) due to sleeplessness and lack of appetite, leading to chronic ischemic pain. Moreover, variable albumin is a crucial index for evaluating a patient's nutritional condition, and hypoproteinemia is a risk factor for amputation in PAD ( 21 , 22 ).…”

Low Hemoglobin Concentration Is Associated With Poor Outcome After Peripheral Arterial Surgery

“…[1][2][3] Patients with peripheral arterial disease (PAD) are prone to anemia of chronic disease. This is likely a consequence of repeated infection and the inflammatory response associated with critical limb ischemia, 4 while iron-deficiency anemia may reflect poor nutrition in others.…”