Predictive Role Of HSCRP As A Biomarker For Adverse Limb Events Following Lower Limb Revascularisation In Patients With CLI: A Prospective Observational Study.

Abstract

Background and Objectives- To evaluate the role of hsCRP in predicting limb loss following revascularisation procedures in patients with PAD, to determine other potential risk factors predicting adverse limb events following revascularisation and to determine the role of hsCRP in predicting the progression of PAD, and need for additional vascular interventions.

Methods- It was a Prospective Observational Study conducted in the Department of General Surgery, Department of Vascular Surgery, JSS Hospital, Mysuru between August 2022 to January 2024 (18 months). Purposive Sampling techniques was used. Total of 60 cases were included. Pre-procedural hsCRP levels were recorded. Follow-up for 6 months’ post procedure, to assess outcome – vascular reintervention, major amputation (above the ankle), death, or limb salvage.

Results- The majority of patients had CLI involving the femoro-popliteal segment (51.7%), whereas in 28.3% of the patients, there was disease involving the below-knee segment, while the iliofemoral segment was involved in 20% of the study population. Pre-procedural hsCRP (on the morning of the procedure) was analysed and was found to be elevated (>5.0 mg/l) in 43.3% of the study population. The Chi² test was performed to assess the association between elevated hsCRP levels, and the outcome of lower extremity amputations (LEAs) upto 6 months from the initial procedure. The Chi-square value of 6.067 was found to be statistically significant with a p-value of 0.048, thereby rejecting the null hypothesis.  Out of the 60 cases, the model correctly predicted the outcome for 46 (76.67%) of them. 

Conclusion- This study investigated the role of hsCRP as a predictive biomarker for limb loss following revascularization procedures. The findings revealed a significant association between elevated hsCRP levels and higher rates of adverse limb events, underscoring the potential utility of hsCRP in pre-operative risk stratification and patient management.