Meaning of catabolic markers in acute limb ischemia

Abstract

Background: Acute limb ischemia is still a challenge due to its high rates of death and complications. Acute limb ischemia also occurs in catabolic patients with low metabolic compensation reserve. Although, catabolism is a defense mechanism triggered by ischemic stress, it does not improve the results of surgical treatment. The aim of the study was an assessment of the metabolic status of the patients treated surgically without success due to acute reversible limb ischemia.
Material and methods: A retrospective, multi-center analysis based on the data received from the hospitals of Zachodniopomorskie district was carried out. A group of 536 patients received surgical treatment due to acute limb ischemia. We included patients with potentially reversible acute limb ischemia, meaning those at a stage less than III on the SVS scale. The patients were qualified initially to undergo revascularization based on current guidelines. Blood tests for the biochemistry panel were performed on every patient on admission. Moreover, we were looking for a connection between metabolic status and the risk of early death.
Results: A good result (survival and saving of limb) was achieved in 75.93% (407 patients). However, we also observed at mortality rate of 13.06% (70 patients) in the entire group. In a multifactor discriminate analysis, we isolated two indicators of increased catabolism: a urea level of above 60mg/dl and a leucocytes count above 12 G/L (Wilk’s Lambda: 0.90724, p < 0.00001).
Conclusions: 1. Catabolic patients have a lower chance of surviving acute limb ischemia. 2. Urea concentration above 60 mg/dl is a reliable indicator suggesting increased catabolism.