A systematic review of the accuracy of prognostic tests and scoring systems for use in the Global Vascular Guidelines' PLAN concept for the treatment of chronic limb threatening ischaemia

The 2019 Global Vascular Guidelines recommend risk assessment for evidence based revascularization based on the acronym PLAN; Patient risk, Limb severity and ANatomical complexity of disease. This meta-analysis compares a multitude of prognostic tests within these categories.INTRODUCTIONThe 2019 Global Vascular Guidelines recommend risk assessment for evidence based revascularization based on the acronym PLAN; Patient risk, Limb severity and ANatomical complexity of disease. This meta-analysis compares a multitude of prognostic tests within these categories.A systematic review and meta-analysis of tests that estimated 1 year major event (amputation free survival and major adverse limb events) probability. Individual patient data were reconstructed from survival estimate curves. With presence or absence of major events; sensitivity, specificity and area-under-receiver operating characteristics curves (AUC) were computed. Tests with an AUC ≥70%, or that correlated with revascularization feasibility were included. Practical application of tests was assessed to make a recommendation on PLAN implementation.METHODSA systematic review and meta-analysis of tests that estimated 1 year major event (amputation free survival and major adverse limb events) probability. Individual patient data were reconstructed from survival estimate curves. With presence or absence of major events; sensitivity, specificity and area-under-receiver operating characteristics curves (AUC) were computed. Tests with an AUC ≥70%, or that correlated with revascularization feasibility were included. Practical application of tests was assessed to make a recommendation on PLAN implementation.Ninety-six studies describing 77 unique predictive techniques were included, of which thirteen were sufficient. These 13 tests were divided in 4 Patient risk (5 studies), 3 Limb severity (3 studies) and 6 Anatomical complexity of disease (9 studies).RESULTSNinety-six studies describing 77 unique predictive techniques were included, of which thirteen were sufficient. These 13 tests were divided in 4 Patient risk (5 studies), 3 Limb severity (3 studies) and 6 Anatomical complexity of disease (9 studies).Three tests were included; Biochemical assessment of calprotectin and CRP, radiological measurement of sarcopenia and predictive score with the GermanVasc CLTI score. These tests scored AUCs of 82.0%, 72.7% and 71.8% respectively, of which the GermanVasc CLTI score was deemed most applicable in clinical practic