Abstract

Aim: Peripheral artery disease (PAD) is a heterogeneous atherosclerotic process shaped by segment-specific lipid and inflammatory mechanisms. This study aimed to evaluate the diagnostic and predictive value of these parameters in distinguishing disease localization by comparing atherogenic (AIP, CRI-I/II) and systemic inflammatory (SIRI, AISI, NLR, SII) biomarker profiles between proximal and distal PAD.
Material and Methods: This single-center retrospective cohort study (2020–2025) screened 782 patients with PAD confirmed by angiography. After propensity score matching for key covariates, 150 proximal and 150 distal cases were analyzed. Laboratory data from ±14 days of the imaging date were used to calculate the lipid (AIP, CRI-I, CRI-II) and hematological-inflammatory indices (NLR, SII, SIRI, AISI). Comparative, regression, and ROC analyses were performed.
Results: In distal PAD, AIP, SIRI, AISI, and CRP values were significantly higher, whereas in proximal PAD, CRI-I/II and NLR values were higher. In multivariate analysis, SIRI remained the strongest independent predictor of distal disease. ROC analysis identified SIRI as the most sensitive predictor of distal PAD and CRI-II as the most specific predictor of proximal PAD. Clinically, distal PAD is associated with a high prevalence of diabetes mellitus (DM) and chronic kidney disease (CKD).
Conclusion: This study highlights that readily accessible hematological and lipid-derived indices can distinguish between proximal and distal PAD phenotypes, reflecting different pathophysiological mechanisms. This study aimed to integrate these inexpensive biomarkers into clinical assessment to improve early risk classification, guide phenotype-specific treatment, support personalized treatment strategies, and ultimately improve clinical decision-making in patients with PAD.

Key words: Peripheral artery disease, atherogenic index of plasma, castelli risk index, systemic inflammation response index, aggregate index of systemic inflammation