J Korean Soc Emerg Med.  2013 Oct;24(5):591-598.

The Characteristics and Factors Affecting Patients Diagnosed with Lower Limb Arteriosclerosis Obliterans in an Emergency Department

• Kang SY
• Kwon OY
• Lee JS
• Choi HS
• Hong HP
• Ko YG

Abstract

PURPOSE
This study investigated the relationship between the laboratory results of patients diagnosed with lower limb arteriosclerosis obliterans (LASO) in an emergency department (ED), general characteristics, clinical manifestation, hematological conditions, and clinical views of severity. Another purpose of the study was to determine the factors that could contribute to clinical severity to facilitate the prediction and diagnosis of LASO in the ED.
METHODS
From January 2005 to December 2012 we conducted a retrospective study on patients diagnosed with LASO in the ED. Included in the study were 52 patients diagnosed with LASO through CT. The patients were divided into two groups according to the Fontaine classification-for comparative analysis: "less severe" (for stage II and below) and "more severe" (for stage III and above). Vital signs, clinical findings, laboratory data, and CT findings were analyzed in each patient. The SPSS package with the Mann-Whitney U test, Fisher's exact test, and logistic regression were used for data analysis. A p-value <0.05 was considered statistically significant.
RESULTS
The average age of patients diagnosed with LASO was 73.1+/-10.1 and male saccounted for 76.9% of the population (n=40). Based upon the levels of severity by the Fontaine classification, patients were divided into 28 "more severe" and 24 "less severe" cases. The "more severe" LASO patients showed a high pulse rate (p=0.017) and a higher current smoking rate (p=0.04). The laboratory data from "more severe" LASO patients showed significant differences in total white blood cell count (p=0.040), erythrocyte sedimentation rate (p=0.000), and the levels of lactate dehydrogenase (p=0.002), creatine kinase (p=0.000), creatine kinase-MB (p=0.002), myoglobin (p=0.000), and C-reactive protein (p=0.000). The significant factors that could affect clinical severity were erythrocyte sedimentation rate (OR 1.066, 95% CI 1.010-1.125, p=0.021), and the levels of lactate dehydrogenase (OR 1.015, 95% CI 1.002-1.029, p=0.027), creatine kinase-MB (OR 1.229, 95% CI 1.028-1.468, p=0.023), and C-reactive protein (OR 1.533, 95% CI 1.074-2.188, p=0.019).
CONCLUSION
The patients diagnosed with more severe LASO showed a high pulse rate, a higher current smoking rate, high levels of inflammation (erythrocyte sedimentation rate and C-reactive protein), and high levels of muscle enzymes (lactate dehydrogenase, creatine kinase, myogolobin, creatine kinase-MB). The factors that could influence clinical severity were erythrocyte sedimentation rate, and the levels of lactate dehydrogenase, creatine kinase-MB, and C-reactive protein.

Keyword

Arteriosclerosis ibliterans; Fontaine classification; Peripheral arterial Disease; Vascular disease

MeSH Terms

Arteriosclerosis Obliterans*
Arteriosclerosis*
Blood Sedimentation
C-Reactive Protein
Classification
Creatine
Creatine Kinase
Diagnosis
Emergencies*
Heart Rate
Humans
Inflammation
L-Lactate Dehydrogenase
Leukocyte Count
Logistic Models
Lower Extremity*
Male
Muscles
Myoglobin
Oxidoreductases
Peripheral Arterial Disease
Retrospective Studies
Smoke
Smoking
Statistics as Topic
Vascular Diseases
Vital Signs
C-Reactive Protein
Creatine
Creatine Kinase
L-Lactate Dehydrogenase
Myoglobin
Oxidoreductases
Smoke