Risk factors for mortality in patients with peripheral artery disease: An umbrella analysis.

Abstract

<h4>Background</h4>This study provides an umbrella review to assess the methodological quality, biases and reliability of evidence regarding the factors influencing mortality in individuals with peripheral artery disease (PAD). It also offers a consolidated overview of the identified risk factors.<h4>Methods</h4>The review protocol was registered in PROSPERO (CRD42024615105). PubMed, Web of Science, the Cochrane Database of Systematic Reviews and Embase were used to search, covering the period from inception until September 2024. AMSTAR and GRADE were used to independently evaluate the methodological rigour and quality of the evidence.<h4>Results</h4>The review identified a total of 29 risk factors, of which 17 were significantly associated with higher mortality risk, while 12 did not show a notable association. The majority of the evidence was rated as low or very low quality, with only three risk factors being classified as having moderate-quality evidence. Key findings indicated that comorbidities such as chronic kidney disease, diabetes, underweight status, atrial fibrillation and depression were major contributors to higher mortality risk. In contrast, obesity and statin use were identified as being linked to a reduced risk of mortality. Additionally, blood biomarkers, including N-terminal pro-B-type natriuretic peptide, high-sensitivity C-reactive protein (CRP) and high-sensitivity cardiac troponin T, were identified as important predictors of mortality.<h4>Conclusion</h4>Comorbid conditions are key factors contributing to elevated mortality among individuals with PAD, whereas obesity and statin use are linked to reduced mortality risk. Additionally, blood biomarkers offer valuable insights into assessing mortality risk within this patient group.