The Monocyte/High Density Lipoprotein Cholesterol Ratio (MHR) as an Indicator of the Need for Amputation in Patients With Peripheral Artery Disease Developing Critical Limb Ischemia

The monocyte/high density lipoprotein cholesterol ratio (MHR) reflects the proatherogenic and antiatherogenic balance, and a high ratio is associated with the severity of atherosclerosis. We measured the MHR of patients with critical limb ischemia (CLI) due to peripheral artery disease (PAD) requiring amputation. Patients diagnosed with PAD were divided into 2 groups; those who underwent an amputation due to CLI without any sign of infection and those treated with surgical or percutaneous revascularization or followed up medically. A healthy control group was also included. In patients diagnosed with PAD (n = 563), the MHR value was higher for the control group (n = 200), (12.4 +/- 0.42 vs 11.5 +/- 0.28, P < .001). In the amputation group, the MHR was significantly higher for the group treated by other methods (15.7 +/- 1.52 vs 12.8 +/- 1.45, P < .001). Possible confounding factors affecting the MHR value were determined by the univariate regression analysis, and the multiple regression analysis revealed that MHR was an independent predictor of amputation in patients with PAD (P < .001). This study suggests that the MHR may be the predictor of amputation risk in patients with PAD and CLI.