Background and Aims

No definitive molecular associations have been described that could explain the difference in outcomes after endovascular treatment in diabetic patients with peripheral artery disease (PAD) and chronic limb-threatening ischemia (CLTI).

This study describes the relationship between the level of the major cytokines involved in diabetic atherosclerosis and the correlation of inflammatory biomarkers at baseline with outcomes after endovascular procedures in diabetic patients with PAD and CLTI. In particular, we studied the TNF-a, IL-6, CRP and osteoprotegerin (OPG) levels.

Methods

We evaluated the relationship between the levels of the major cytokines associated with diabetic atherosclerosis and the outcomes after endovascular procedures in diabetic patients with PAD and CLTI.

Results

299 patients with below-the-knee occlusive disease undergoing an angioplasty procedure were enrolled. The levels of key cytokines, osteoprotegerin (OPG), tumor necrosis factor-a (TNF-a), 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 at 1, 3, 6 and 12 months post procedure.

There was a linear trend from lowest to highest quartile for each cytokine at baseline and incident MALE. A linear association between increasing levels of each cytokine and incident MACE was also observed. Receiver operating characteristics (ROC) 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-a, IL-6 and CRP levels at baseline correlate with worse vascular outcomes in diabetic patients with PAD and CLTI undergoing an endovascular procedure.