Anemia, Glycemia, and Inflammation in PAD-Related Tissue Necrosis

Objective: To determine whether systemic inflammation in peripheral artery disease is primarily associated with necrosis or a secondary response, we evaluated the association of tissue oxygenation (red blood cells), acute metabolic stress (admission glucose, albumin), systemic inflammation (C-reactive protein), and the red blood cell-to-albumin ratio. Materials and Methods: We retrospectively analyzed 375 patients undergoing endovascular interventions (58 with necrosis, 317 without). C-reactive protein-to-albumin and red blood cell-to-albumin ratios were calculated. Associations were assessed using parallel multivariate logistic regression models. Results: The necrosis group had significantly higher admission glucose and C-reactive protein-to-albumin ratio, but a lower red blood cell count and red blood cell-to-albumin ratio. In multivariate models of fundamental biomarkers, C-reactive protein lost independent significance; low red blood cells (Odds Ratio: 0.348, p = 0.0003) and elevated admission glucose (Odds Ratio: 1.008, p = 0.0018) were the strongest independently associated variables. In composite index models, the C-reactive protein-to-albumin ratio became a dominant associated factor, attenuating the red blood cell-to-albumin ratio’s statistical significance. Conclusions: Anemia and admission hyperglycemia are strong correlates of tissue necrosis. Systemic inflammation appears to act as a secondary consequence of ischemic injury but profoundly exacerbates tissue loss when combined with nutritional depletion. Comprehensive medical management, including anemia correction and metabolic optimization, is fundamental for limb salvage.