Editor's Choice – The Prognostic Value of the WIfI Classification in Patients with Chronic Limb Threatening Ischaemia: A Systematic Review and Meta-Analysis

• Published in: European journal of vascular and endovascular surgery 2019-09, Vol.58 (3), p.362-371
• Main Authors: van Reijen, Nick S, Ponchant, Kevin, Ubbink, Dirk T, Koelemay, Mark J.W
• Format: Article
• Language: English
• Subjects: Amputation; Amputation - trends; Chronic Disease; Classification; Computer Communication Networks; Diabetic foot; Humans; Ischaemia; Ischemia - classification; Ischemia - diagnosis; Ischemia - surgery; Lower Extremity - blood supply; Peripheral arterial disease; Prognosis; Risk Assessment - methods; Severity of Illness Index; Surgery
• ISSN: 1078-5884; 1532-2165
• DOI: 10.1016/j.ejvs.2019.03.040

ObjectivesThe Society for Vascular Surgery has proposed the Wound, Ischaemia, and foot Infection (WIfI) classification system as a prognostic tool for the one year amputation risk and the added value of revascularisation in patients with chronic limb threatening ischaemia (CLTI). This systematic review summarises the current evidence on the prognostic value of the WIfI classification system in clinical practice. DesignSystematic review and meta-analysis following the PRISMA guidelines. MaterialsThe Embase, MEDLINE, and Cochrane databases were searched up to June 2018. MethodsAll studies using the WIfI classification for patients with CLTI were eligible. Outcomes of interest were major amputation, limb salvage, and amputation free survival in relation to WIfI clinical stage. The methodological quality of studies was appraised with the Quality in Prognosis Studies (QUIPS) tool. If possible, data were pooled and analysed using a random effects model. Study selection, quality assessment, and data extraction were carried out by two authors independently. ResultsThe search yielded 12 studies comprising 2669 patients, most of whom underwent endovascular or open revascularisation. Overall study quality was moderate. All but one were retrospective studies, including a variety of subpopulations of patients with CLTI, such as only haemodialysis dependent, diabetic or non-diabetic patients. The WIfI classification was derived from chart data or prospectively maintained databases, both documented before the WIfI classification was published. Estimated one year major amputation rates from four studies comprising 569 patients were 0%, 8% (95% CI 3–21%), 11% (95% CI 6–18%) and 38% (95% CI 21–58%), for WIfI stages I–IV, respectively. ConclusionsThe likelihood of an amputation after one year in patients with CLTI increases with higher WIfI stages, which is important prognostic information. Prospective evaluations are needed to determine its role in clinical practice.