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Systemic vasculitis is associated with a higher risk of lower extremity amputation in patients with severe peripheral arterial occlusive disease: a secondary analysis of a nationwide, population-based health claims database

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Abstract

Previous research has shown that diabetes mellitus increases the risk of lower extremity amputation in patients with peripheral arterial occlusive disease. However, to our knowledge, no studies have investigated whether systemic autoimmune disease, in particular systemic vasculitis is associated with a higher risk of lower extremity amputation in these patients. To investigate the association between systemic autoimmune disease and lower extremity amputation in patients with severe peripheral arterial occlusive disease based on a secondary analysis of a nationwide, population-based health claims database. Using the inpatient datafile of the Taiwan’s National Health Insurance Research Database (NHIRD), we identified 432 patients with severe peripheral arterial occlusive disease that required hospitalization between 2000 and 2012. We also identified patients who had undergone lower extremity amputation and their comorbidities using the same datafile. The risk of lower extremity amputation was assessed using multiple logistic regression analysis, adjusting for age, sex, insured amount, the urbanization level of residence, and the presence of comorbidities. Among patients with severe peripheral arterial occlusive disease, those with systemic vasculitis exhibited a significant higher risk of lower extremity amputation (adjusted odds ratio [aOR] = 6.82, p < 0.001). Diabetes mellitus (aOR = 4.90, p < 0.001) and chronic obstructive pulmonary disease (aOR = 2.87, p = 0.007) were also significantly associated with a higher risk of lower extremity amputation. Among patients with severe peripheral arterial occlusive disease, a significantly higher risk of lower extremity amputation was observed in those with systemic vasculitis.

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Author notes

  1. Ming-Chi Lu, Honda Hsu and Ching-Hsing Lin contributed equally to this work.

Authors and Affiliations

  1. Division of Allergy, Immunology and Rheumatology, Department of Internal Medicine, Dalin Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Dalin, Chiayi, Taiwan

    Ming-Chi Lu

  2. School of Medicine, Tzu Chi University, Hualien City, Taiwan

    Ming-Chi Lu

  3. Division of Plastic Surgery, Department of Surgery, Dalin Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Dalin, Chiayi, Taiwan

    Honda Hsu

  4. Division of Orthopedics, Department of Surgery, Dalin Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Dalin, Chiayi, Taiwan

    Ching-Hsing Lin

  5. Department of Medical Research, Dalin Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, 2 Minsheng Road, Dalin, 62247, Chiayi, Taiwan

    Malcolm Koo

  6. Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada

    Malcolm Koo

Authors
  1. Ming-Chi Lu
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  2. Honda Hsu
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  3. Ching-Hsing Lin
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  4. Malcolm Koo
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Corresponding author

Correspondence to Malcolm Koo.

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Ethical approval

The study protocol was reviewed and approved by the institutional review board of the Dalin Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Taiwan (No. B10104020 and B10004021)

Human rights

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards

Informed consent

Since the NHIRD data files contain only de-identified secondary data, the need for informed consent from each individual patient was waived by the institutional review board.

Conflict of interest

Ming-Chi Lu, Honda Hsu, Ching-Hsing Lin, and Malcolm Koo declare that they have no conflict of interest.

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Lu, MC., Hsu, H., Lin, CH. et al. Systemic vasculitis is associated with a higher risk of lower extremity amputation in patients with severe peripheral arterial occlusive disease: a secondary analysis of a nationwide, population-based health claims database. Rheumatol Int 37, 1847–1852 (2017). https://doi.org/10.1007/s00296-017-3828-9

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  • DOI: https://doi.org/10.1007/s00296-017-3828-9

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