Abstract
Aims: Liver dysfunction may affect chronic limb-threatening ischemia (CLTI) outcomes, but its impact on survival and lipid profiles is unclear. To assess the association of liver dysfunction using the Albumin–Bilirubin (ALBI) score, with survival, liver fibrosis, and cholesterol in CLTI patients.
Methods: We retrospectively analyzed single-center data of CLTI patients with below-knee lesions between 2008–2018. ALBI scores were calculated from serum albumin and total bilirubin. Optimal cutoff for 3-year overall survival (OS) was determined by receiver operating characteristic (ROC) analysis, dividing patients into high and low ALBI groups. Patient characteristics, cholesterol, and liver fibrosis (FIB-4 index) were compared, with primary endpoint being 3-year OS.
Results: Among 263 patients, high ALBI patients (≥ -2.36, n = 135) were older (80 vs. 72 years), included fewer males (55% vs. 71%), had higher prevalence of bed-ridden status (44% vs. 2%) and heart failure (25% vs. 8%; all P＜0.01). They had higher FIB-4 index (2.49 vs. 1.76), lower total cholesterol (147 vs. 173 mg/dL), HDL-C (43 vs. 56 mg/dL), LDL-C (83 vs. 108 mg/dL), and higher LDL-C/HDL-C ratio (2.57 vs. 2.20; P＜0.01). Three-year OS was lower in high ALBI group (36% vs. 57%; P＜0.01) and remained lower after propensity matching (43% vs. 55%; P = 0.04). Multivariate analysis identified low body mass index (BMI), heart failure, high ALBI score and high FIB-4 index (≥ 1.3) and low LDL-C (＜100 mg/dL) as predictors of poor OS.
Conclusions: High ALBI scores in CLTI patients links to liver fibrosis, disturbed lipid profiles, and reduced survival.
