Association of the Naples Prognostic Score with Long-Term Adverse Events in Chronic Limb-Threatening Ischemia After Below-the-Knee Endovascular Revascularization

Abstract

Objectives: Chronic limb-threatening ischemia (CLTI) is the most severe manifestation of peripheral artery disease (PAD) and is associated with high morbidity and mortality. The Naples prognostic score (NPS), a composite marker incorporating serum albumin, total cholesterol, neutrophil-to-lymphocyte ratio (NLR), and lymphocyte-to-monocyte ratio (LMR), has shown prognostic value in various cardiovascular conditions. This study aimed to evaluate the prognostic significance of the NPS in predicting all-cause mortality and any kind of amputation in patients with CLTI undergoing endovascular treatment (EVT) for below-the-knee (BTK) lesions. Methods: In this retrospective analysis, 191 patients diagnosed with CLTI and treated with EVT for BTK lesions between 2017 and 2023 were stratified into three groups based on the NPS: low (0–1), intermediate (2), and high (3–4). The primary endpoint was all-cause mortality, while the secondary endpoint was any kind of amputation. Results: A higher NPS was significantly associated with increased all-cause mortality (hazard ratio: 3.66; 95% confidence interval: 1.72–7.78; p < 0.001), while no significant association was observed between the NPS and major amputation. Independent predictors of mortality included a high NPS, reduced left ventricular ejection fraction, and impaired renal function. Conclusions: The NPS is an independent predictor of long-term mortality in CLTI patients undergoing EVT for BTK lesions.

Keywords

• peripheral arterial disease
• chronic limb-threatening ischemia
• Naples prognostic score
• mortality
• adverse events