Younger patients with chronic limb threatening ischemia face more frequent amputations.
Younger patients with chronic limb threatening ischemia face more frequent amputations.
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DOI：
10.1016/j.ahj.2021.08.002
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发表时间：
2021-12
影响因子：
4.8
通讯作者：
Jones WS
中科院分区：
文献类型：
--
作者：
Weissler EH;Ford CB;Patel MR;Goodney P;Clark A;Long C;Jones WS
患有慢性肢体威胁性缺血（CLTI）的年轻患者截肢可能会带来更高的个人和社会成本，但由于数据集的限制，年轻患者通常不包括在CLTI研究中。我们的目的是描述和比较年轻（<65岁）和老年CLTI患者的结果。这项回顾性队列研究在MarketScan商业索赔数据库中确定了2014年7月1日至2017年12月31日期间的CLTI患者，该数据库是美国超过5000万私人保险患者的专有索赔集。主要结局为主要肢体不良事件（MALE）；次要结局包括截肢、主要不良心血管事件和他汀类药物处方填充。该研究队列包括64,663例CLTI患者，其中25,595例（39.6%）年龄<65岁。年轻患者患糖尿病的可能性更高（54.1%对49.9%,p< 0.001），但患其他合并症的可能性更低。年轻患者患MALE的比例较高（31.7%比30.2%,p= 0.002），特别是截肢（11.5%比9.3%,p< 0.001）。调整后，年龄<65岁的患者截肢风险增加24% (HRadj 1.24, 95%CI 1.18-1.32, p< 0.001)， MALE风险增加10% （HRadj 1.10, 95%CI 1.07-1.14, p< 0.001）。在商业保险的CLTI患者中，65岁以下的患者占很大比例，年轻患者的肢体相关预后较差。这些发现强调了积极治疗动脉粥样硬化危险因素的重要性，并有意在未来的分析中纳入年轻的CLTI患者，以更好地了解他们的疾病模式和结果。
Amputations among younger patients with chronic limb threatening ischemia (CLTI) may carry higher personal and societal costs, but younger patients are often not included in CLTI research because of dataset limitations. We aimed to characterize and compare outcomes between younger (<65 years old) and older patients with CLTI. This retrospective cohort study identified patients with CLTI between July 1, 2014 and December 31, 2017 in the MarketScan commercial claims database, a proprietary set of claims for over 50 million patients with private insurance in the United States. The primary outcome was major adverse limb events (MALE); secondary outcomes included amputations, major adverse cardiovascular events, and statin prescription fills. The study cohort included 64,663 people with CLTI, of whom 25,595 (39.6%) were <65 years old. Younger patients were more likely to have diabetes mellitus (54.1% versus 49.9%, p<.001) but less likely to have other comorbidities. A higher proportion of younger patients suffered MALE (31.7% versus 30.2%, p=.002), specifically amputation (11.5% versus 9.3%, p<.001). After adjustment, age <65 years old was associated with a 24% increased risk of amputation (HRadj 1.24, 95%CI 1.18–1.32, p<.001) and a 10% increased risk of MALE (HRadj 1.10, 95%CI 1.07–1.14, p<.001). A significant proportion of commercially insured patients with CLTI are under the age of 65, and younger patients have worse limb-related outcomes. These findings highlight the importance of aggressively treating risk factors for atherosclerosis and intentionally including younger patients with CLTI in future analyses to better understand their disease patterns and outcomes.
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