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Validation of WIfI System to Predict Limb Salvage and Mortality
Zdenek Novak, MD, PhD, MSHI, Benjamin J. Pearce, MD, Gaurav Parmar, MD, Thomas C. Matthews, MD, Mark A. Patterson, MD, Marc A. Passman, MD, William D. Jordan, Jr., MD.
University of Alabama at Birmingham, Birmingham, AL, USA.
OBJECTIVES: The SVS recommended Wifi Scoring system for critical limb ischemia (CLI) is increasingly being used to codify evaluation and reporting of patients with limb threat. Existing data have validated the methodology, but clinical applicability is not completely understood. The purpose of this study is to validate WIfI system in clinical practice and evaluate its predictive value for outcomes of limb salvage and mortality.
METHODS: A total of 427 CLI patients were assigned WIfI score and entered into a prospective vascular database between January 2014 and June 2015. The patients were divided into groups based on procedure performed within 1 month after WIfI score was assigned: Endovascular treatment (ENDO), Open revascularization (OPEN) and major amputation (AMP) and their respective combinations. The worst WIfI score from both LE was used in a logistic analysis for death and side matched procedure was used for all other analyses. U-test, Chi-square and Multivariate logistic regression were used in statistical analysis with p>=0.05 being considered significant.
RESULTS: Of the original 427 patients, 306 underwent an operative intervention with the remaining 121 receiving only medical therapy. Amputation occurred in 16 (5.2%) of OPEN patients, 16 (5.2%) of ENDO patients, and 1 patient (0.3%) who had both therapies. Immediate major amputation was performed in 54 patients (17.6%) for an overall amputation rate of 28.3%. Wound score (p=0.005, RR=1.89), Age (p=0.011, RR=1.04) and CAD (p=0.002, RR=4.10) were predictive of mortality. The only portion of WIfI predictive of major amputation was Wound score (p<0.001, RR=3.11). However, threshold analysis suggests that any score above 0 for Wound and/or Infection is associated with major amputation (both p<0.001) and incidence of amputation approximately doubles with each increase in grade of wound score.
CONCLUSIONS: This analysis shows that wound grade is the most predictive factor of WIFi for patient’s survival and limb salvage. Infection has implication for limb salvage; however, ischemia score is not predictive of outcome.
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