Inflammatory Cytokines Associated With Failure of Lower-Extremity Endovascular Revascularization (LER): A Prospective Study of a Population With Diabetes

Diabetes Care. 2019 Oct;42(10):1939-1945. doi: 10.2337/dc19-0408. Epub 2019 Aug 1.

Abstract

Objective: Peripheral artery disease (PAD) is one of the most relevant complications of diabetes. Although several pharmacological and revascularization approaches are available for treating patients with diabetes and PAD, an endovascular approach is often associated with postprocedural complications that can increase the risk for acute limb ischemia or amputation. However, no definitive molecular associations have been described that could explain the difference in outcomes after endovascular treatment in patients with diabetes, PAD, and chronic limb-threatening ischemia (CLTI).

Research design and methods: We evaluated the relationship between the levels of the main cytokines associated with diabetic atherosclerosis and the outcomes after endovascular procedures in patients with diabetes, PAD, and CLTI.

Results: A total of 299 patients with below-the-knee occlusive disease who were undergoing an angioplasty procedure were enrolled. The levels of key cytokines-osteoprotegerin (OPG), tumor necrosis factor-α (TNF-α), interleukin-6 (IL-6), and C-reactive protein (CRP)-were measured, and major adverse limb events (MALE) and major adverse cardiovascular events (MACE) were assessed 1, 3, 6, and 12 months after the procedure. There was a linear trend from the lowest to the highest quartile for each cytokine at baseline and incident MALE. A linear association was also observed between increasing levels of each cytokine and incident MACE. Receiver operating characteristics models were constructed using clinical and laboratory risk factors, and the inclusion of cytokines significantly improved the prediction of incident events.

Conclusions: We demonstrated that elevated OPG, TNF-α, IL-6, and CRP levels at baseline correlate with worse vascular outcomes in patients with diabetes, PAD, and CLTI undergoing an endovascular procedure.

MeSH terms

  • Aged
  • Aged, 80 and over
  • Amputation, Surgical / statistics & numerical data
  • Atherosclerosis / etiology
  • Atherosclerosis / physiopathology
  • Atherosclerosis / surgery
  • Cytokines / blood*
  • Diabetes Mellitus* / blood
  • Diabetes Mellitus* / epidemiology
  • Diabetes Mellitus* / physiopathology
  • Diabetes Mellitus* / surgery
  • Diabetic Angiopathies / physiopathology
  • Diabetic Angiopathies / surgery*
  • Endovascular Procedures* / adverse effects
  • Endovascular Procedures* / statistics & numerical data
  • Female
  • Follow-Up Studies
  • Humans
  • Incidence
  • Inflammation Mediators / blood*
  • Ischemia / blood
  • Ischemia / epidemiology
  • Ischemia / surgery
  • Limb Salvage / adverse effects
  • Limb Salvage / methods
  • Lower Extremity / blood supply
  • Lower Extremity / surgery*
  • Male
  • Middle Aged
  • Peripheral Arterial Disease / blood
  • Peripheral Arterial Disease / epidemiology
  • Peripheral Arterial Disease / physiopathology
  • Peripheral Arterial Disease / surgery*
  • Prospective Studies
  • Risk Factors
  • Treatment Failure
  • Treatment Outcome

Substances

  • Cytokines
  • Inflammation Mediators