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Analysis of in-hospital deaths in patients with critical limb ischemia necessitating invasive treatments: based on a Japanese nationwide database

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Abstract

Critical limb ischemia (CLI) is associated with systemic cardiovascular and non-cardiovascular diseases. Treatments primarily targeting limb-related outcomes may not improve overall life prognosis. We aimed to describe in-hospital mortality and the underlying etiologies in Japanese patients with CLI. We analyzed the Diagnosis Procedure Combination (DPC) database from approximately 1200 Japanese acute-care hospitals between April 2018 and March 2020. The definition of patients with CLI was based on the diagnostic codes listed as the most resource-intensive diagnosis and information regarding invasive procedures (endovascular treatment, bypass, or amputation). The DPC database provides information on whether in-hospital death was caused by the most resource-intensive diagnosis. Among 15,228 distinct patients with CLI, we identified 18,970 records, including 5,378 amputations. In-hospital death occurred in 1238 (6.5%) patients. Among them, 811 (65.5%) were due to causes unrelated to CLI. In patients who underwent amputation (n = 5378), causes unrelated to CLI accounted for 70.0% of in-hospital deaths, whereas among patients who did not undergo amputation (n = 13,592), this proportion was 60.1%. When compared to patients who died due to causes related to CLI, the prevalence of male patients was higher (62.6% vs 52.7%, p = 0.001), and amputation was more frequently performed (58.0% vs 47.1%, p < 0.001) in those who died due to causes unrelated to CLI. The majority of in-hospital deaths among patients with CLI necessitating endovascular treatment, bypass, or amputation were attributable to factors unrelated to the primary condition of CLI. Managing systemic cardiovascular and non-cardiovascular diseases beyond the affected limb is crucial to improve the prognosis of these patients.

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Abbreviations

ADL:

Activity of daily living

CLI:

Critical limb ischemia

COPD:

Chronic obstructive pulmonary disease

DL:

Dyslipidemia

DM:

Diabetes mellitus

DPC:

Diagnosis Procedure Combination

EVT:

Endovascular treatment

GLASS:

Global Limb Anatomic Staging System

HT:

Hypertension

ICD:

International Classification of Diseases

JCS:

Japan Coma Scale

LEAD:

Lower extremity artery disease

LOS:

Length of hospital stay

WifI:

Wound, Ischemia, and Foot Infection

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Acknowledgements

The authors express their heartfelt gratitude to all the participants. We thank Prof. Dr. Yoshikazu Yonemitsu from the Graduate School of Pharmaceutical Sciences, Kyushu University, and Dr. Akino Uejo from the Department of Vascular Surgery, Makiminato Chuo Hospital, for their helpful advice in developing our research ideas, and Ms. Yuki Endo, Ms. Fumie Shibuya, and Ms. Hiromi Shiina, the health information managers at Yokohama City University Hospital. This research was supported by the Okinawa Prefecture under the Advanced Medical Industry Promotion Program.

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Author notes

  1. Kiwamu Iwata and Manabu Nitta have contributed equally.

Authors and Affiliations

  1. Department of Cardiology, Yokohama City University Graduate School of Medicine, 3-9 Fukuura, Kanazawa, Yokohama, Kanagawa, 236-0004, Japan

    Kiwamu Iwata & Manabu Nitta

  2. Wellbe Heart Clinic Konandai, 3-19-1-1F, Konandai, Konan, Yokohama, Kanagawa, 234-0054, Japan

    Kiwamu Iwata

  3. Center for Novel and Exploratory Clinical Trials (Y-NEXT), Yokohama City University Hospital, 1-1-1-5F Fukuura, Kanazawa, Yokohama, Kanagawa, 236-0004, Japan

    Manabu Nitta

  4. Department of Health Data Science, Graduate School of Data Science, Yokohama City University, 22-2 Seto, Kanazawa, Yokohama, Kanagawa, Japan

    Manabu Nitta, Makoto Kaneko, Shinichiro Ueda & Sayuri Shimizu

  5. Department of Health Policy and Informatics, Tokyo Medical and Dental University Graduate School of Medical and Dental Sciences, 1-5-45 Yushima, Bunkyo-ku, Tokyo, 113-8519, Japan

    Kiyohide Fushimi

  6. Department of Clinical Pharmacology and Therapeutics, University of the Ryukyus Graduate School of Medicine, 207 Uehara, Nishihara-cho, Okinawa, 903-0215, Japan

    Shinichiro Ueda

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  1. Kiwamu Iwata
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Contributions

Kiwamu Iwata, Manabu Nitta, Makoto Kaneko, Sayuri Shimizu, and Shinichiro Ueda conducted this study. Kiyohhide Fushimi collected the data. Manabu Nitta analyzed the data. Kiwamu Iwata and Manabu Nitta drafted the initial manuscript. Sayuri Shimizu, Makoto Kaneko, Kiyohhide Fushimi, and Shinichiro Ueda supervised the study. All authors have read and approved the final manuscript.

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Correspondence to Manabu Nitta.

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Iwata, K., Nitta, M., Kaneko, M. et al. Analysis of in-hospital deaths in patients with critical limb ischemia necessitating invasive treatments: based on a Japanese nationwide database. Cardiovasc Interv and Ther (2024). https://doi.org/10.1007/s12928-024-01003-7

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