COVID-19 Patients With Peripheral Artery Diseases and Comorbidities: Systematic Review and Meta-analysis

Abstract

Background and Purpose: COVID-19 is a significant cause of hypercoagulability, which is crucial in causing peripheral artery disease (PAD) or exacerbating pre-existing PAD. When comorbidities are present, patients are prone to poor prognosis. Hence, we seek to evaluate the clinical outcomes in COVID-19 patients with PAD and find associated comorbidities. Materials and Methods: A systematic search was performed through PubMed, Cochrane, ProQuest, Scopus, Wiley, and EMBASE using keywords that matched the MeSH browser, such as PAD, COVID-19, and comorbidities, without any date range limitation. Additionally, we utilized Google Scholar to point out additional articles that could be found in the several databases included but were not found due to the keywords. We looked for observational studies of PAD patients with or without comorbidities until July 22, 2023. Results: Twenty-one studies were included in this systematic review and meta-analysis. COVID-19 patients with PAD were associated with significantly higher re-thrombolysis (OR=3.09; 95% CI, 1.31%, 7.28%; P=0.01) and mortality rate (OR=3.82; 95% CI, 1.10%, 13.22%; P=0.03). However, a higher amputation rate than non-COVID-19 patients showed lower significance (OR=2.99; 95% CI, 0.90%, 9.89%; P=0.07), and no significant difference in limb salvage rate was observed (OR=0.58; 95% CI, 0.06%, 5.60%; P=0.64). Comorbidities that show significant associations with COVID-19 patients with PAD were hypertension (67.0%; 95% CI, 0.54%, 0.80%), diabetes mellitus (DM) (50.0%; 95% CI, 0.37%, 0.62%), hyperlipidemia (47.0%; 95% CI, 0.30%, 0.64%), heart diseases (28.0%; 95% CI, 0.14%, 0.41%), and atrial fibrillation (16.0%; 95% CI, 0.06%, 0.25%). Conclusion: This meta-analysis demonstrates a higher re-thrombosis and mortality rate in PAD patients with COVID-19 infection compared to patients without COVID-19. These events are shown to be higher in diabetes, hypertension, and dyslipidemia individuals. Therefore, further treatments are needed for COVID-19 patients with PAD and cardiovascular comorbidities to prevent worse outcomes and to anticipate the possibilities of new COVID-19 variants as well as long COVID-19 syndrome.