Reversion of the inflammatory markers in patients with chronic limb threatening ischaemia

ABSTRACT Introduction Peripheral arterial disease (PAD) affects over 202 million individuals worldwide, with 1.3% suffering from chronic limb-threatening ischaemia (CLTI). Atherosclerosis, characterized by intense inflammation, is the primary cause of PAD. Inflammation is linked to higher mortality rates, especially in CLTI patients. This study aims to compare the evolution of inflammatory markers between claudication and CLTI patients over three, six, and twelve months. Methods A prospective, single-center observational study was conducted from January 2018 to July 2022. A PAD cohort was observed at admission and at three, six, and twelve months, with data on clinical, analytical, and inflammatory markers collected. The analyzed markers included positive acute phase proteins (C-reactive protein - CRP and fibrinogen) and negative acute phase proteins (albumin, total cholesterol, and high-density lipoprotein - HDL). Results The study involved 119 subjects (mean age: 67.58 ± 9.60 years; 79.80% males), with 65 patients having claudication and 54 with CLTI. At admission, CLTI patients exhibited significantly higher serum levels of CRP and fibrinogen (positive acute phase proteins) and lower levels of albumin, total cholesterol, and HDL (negative acute phase proteins) compared to claudication patients. Three months after CLTI resolution, negative acute phase proteins increased, and positive acute phase proteins decreased. However, no significant changes in inflammatory proteins were observed in patients with claudication over time. Conclusion CLTI patients demonstrate an inflammatory state, which may have deleterious consequences and be partially reversible after the resolution of the ischemic process. Recognizing the potential for reversibility through revascularization/amputation underscores the significance of timely intervention.