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Peer-reviewedCC BY-NC 4.0Clinical and Applied Thrombosis/Hemostasis

Prognostic Value of the Pan-Immune Inflammatory Value and Fibrinogen-To-Albumin Ratio for Amputation in Patients With Lower Extremity Arterial Disease

  • Jing Li1,2
  • Zuoyi Yao3
  • Lu Tang1
  • Qin Chen1,4
  • Xiaoyu Liu1,5
  • Xiaoyan Quan1
  • Pan Song1
  • Qingran Li1,6
  • Chi Cui7
  • Yang Liu8
  • Meihong Shi1
8 affiliations
  1. 1School of Nursing, Southwest Medical University, Luzhou, Sichuan, China
  2. 2Health Management Center, The Affiliated Hospital of Southwest Medical University, Luzhou, Sichuan, China
  3. 3Department of Vascular Surgery, Chengdu Fifth People’s Hospital, Chengdu, Sichuan, China
  4. 4Department of Spine Surgery, The Affiliated Hospital of Southwest Medical University, Luzhou, Sichuan, China
  5. 5Department of Nursing, Jiangjin Hospital of Traditional Chinese Medicine, Chongqing, China
  6. 6Department of Critical Care Medicine, Dazhou Central Hospital, Dazhou, Sichuan, China
  7. 7Department of General Surgery, The Third People’s Hospital of Chengdu, Affiliated Hospital of Southwest Jiaotong University & The Second Affiliated Hospital of Chengdu, Chongqing Medical University, Chengdu, China
  8. 8Department of Vascular Surgery, Hospital of Chengdu University of Traditional Chinese Medicine, Chengdu, Sichuan, China
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Abstract

Background: Lower extremity arterial disease (LEAD) remains a major cause of amputation, even after successful endovascular revascularization therapy (EVT). The prognostic associations of the pan-immune inflammatory value (PIV) and fibrinogen-to-albumin ratio (FAR) in LEAD remain unclear. This study investigated the associations of PIV and FAR with amputation risk and evaluated their incremental prognostic value beyond established clinical variables.

Methods: In this multicenter retrospective cohort study, 1,082 patients with LEAD who underwent EVT at four tertiary hospitals in Southwest China between January 2018 and July 2023 were analyzed. Restricted cubic spline (RCS) analyses and Cox proportional hazards regression models were used to evaluate the associations of PIV and FAR with amputation risk. Exploratory cut-off values were derived using receiver operating characteristic (ROC) curve analysis. The incremental prognostic value of adding PIV and FAR to clinical variables was assessed using time-dependent ROC analysis.

Results: During a median follow-up of 31 months, 198 (18.3%) patients experienced amputation. RCS revealed significant nonlinear associations of PIV and FAR with amputation risk (p for nonlinearity < 0.001). After multivariable adjustment, higher levels of both biomarkers remained independently associated with increased amputation risk (Z-PIV: HR = 1.379; Z-FAR: HR = 1.176; both p < 0.001). The addition of PIV and FAR to the clinical model enhanced time-dependent discrimination; the AUC(t) increased from 0.771 to 0.819 at 1 year, 0.766 to 0.806 at 2 years, and 0.762 to 0.807 at 3 years (all adjusted p < 0.001). Fine-Gray competing-risk analyses yielded consistent results after accounting for death as a competing event.

Conclusion: PIV and FAR were independently associated with amputation risk in patients with LEAD who underwent EVT. The addition of these biomarkers to established clinical variables provided incremental prognostic value and may offer additional prognostic information for risk stratification.

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Cite

BibTeXRIS
BibTeX
@article{li2026prognostic,
  title = {{Prognostic Value of the Pan-Immune Inflammatory Value and Fibrinogen-To-Albumin Ratio for Amputation in Patients With Lower Extremity Arterial Disease}},
  author = {Jing Li and Zuoyi Yao and Lu Tang and Qin Chen and Xiaoyu Liu and Xiaoyan Quan and Pan Song and Qingran Li and Chi Cui and Yang Liu and Meihong Shi},
  journal = {Clinical and Applied Thrombosis/Hemostasis},
  year = {2026},
  month = sep,
  doi = {10.1177/10760296261491923},
  url = {https://doi.org/10.1177/10760296261491923},
  note = {CC BY-NC 4.0},
}
RIS
TY  - JOUR
TI  - Prognostic Value of the Pan-Immune Inflammatory Value and Fibrinogen-To-Albumin Ratio for Amputation in Patients With Lower Extremity Arterial Disease
AU  - Jing Li
AU  - Zuoyi Yao
AU  - Lu Tang
AU  - Qin Chen
AU  - Xiaoyu Liu
AU  - Xiaoyan Quan
AU  - Pan Song
AU  - Qingran Li
AU  - Chi Cui
AU  - Yang Liu
AU  - Meihong Shi
PY  - 2026
DA  - 2026/09/24
JO  - Clinical and Applied Thrombosis/Hemostasis
DO  - 10.1177/10760296261491923
UR  - https://doi.org/10.1177/10760296261491923
AB  - Background: Lower extremity arterial disease (LEAD) remains a major cause of amputation, even after successful endovascular revascularization therapy (EVT). The prognostic associations of the pan-immune inflammatory value (PIV) and fibrinogen-to-albumin ratio (FAR) in LEAD remain unclear. This study investigated the associations of PIV and FAR with amputation risk and evaluated their incremental prognostic value beyond established clinical variables.  Methods: In this multicenter retrospective cohort study, 1,082 patients with LEAD who underwent EVT at four tertiary hospitals in Southwest China between January 2018 and July 2023 were analyzed. Restricted cubic spline (RCS) analyses and Cox proportional hazards regression models were used to evaluate the associations of PIV and FAR with amputation risk. Exploratory cut-off values were derived using receiver operating characteristic (ROC) curve analysis. The incremental prognostic value of adding PIV and FAR to clinical variables was assessed using time-dependent ROC analysis.  Results: During a median follow-up of 31 months, 198 (18.3%) patients experienced amputation. RCS revealed significant nonlinear associations of PIV and FAR with amputation risk (p for nonlinearity < 0.001). After multivariable adjustment, higher levels of both biomarkers remained independently associated with increased amputation risk (Z-PIV: HR = 1.379; Z-FAR: HR = 1.176; both p < 0.001). The addition of PIV and FAR to the clinical model enhanced time-dependent discrimination; the AUC(t) increased from 0.771 to 0.819 at 1 year, 0.766 to 0.806 at 2 years, and 0.762 to 0.807 at 3 years (all adjusted p < 0.001). Fine-Gray competing-risk analyses yielded consistent results after accounting for death as a competing event.  Conclusion: PIV and FAR were independently associated with amputation risk in patients with LEAD who underwent EVT. The addition of these biomarkers to established clinical variables provided incremental prognostic value and may offer additional prognostic information for risk stratification.
SN  - 1076-0296
SN  - 1938-2723
ER  -