Determination of predictors of adverse outcome in patients with acute limb ischemia with a new coronavirus infection in the acute phase of the disease

Abstract

Relevance. At the moment, the study relevance is determined by extremely insufficient coverage of this issue, which in turn directly affects managing patients with this pathology. Study objectives: to analyze outcomes of surgical treatment of patients with acute ischemia of lower limbs in connection with the new coronavirus infection and in­hospital mortality; to identify predictors of adverse outcomes; to construct a prognostic model for patients with acute limb ischemia and severe acute respiratory syndrome­related coronavirus­2 (hereinafter – SARS-­Cov-­2). Material and methods. Study design: single­center, retrospective study. We retrospectively analyzed 47 patients with acute limb ischemia (ALI) on confirmed SARS-Cov­-2 for the period from September 2020 to April 2022. In this study, we analyzed the mean age of patients, laboratory tests results, comorbidities, ischemia grade, imaging data, choice of treatment strategy, and in­hospital mortality. Statistical analysis revealed a correlation between clinical outcomes in patients with ALI and SARS­-Cov-­2 severity. Results. The mean age of the patients was 71.1  6.3 years. Acute ischemia of the upper limb was present in 3 of them. The mean concentration of D­dimer was 4,645 ng/mL. The mean level of ferritin was 969.1 µg/L. SARS-­CoV­-2 was confirmed in 100% of patients. The distribution of ALI grades (according to I.I. Zatevakhin's clasification) was as follows: 1 – 8.5% (n = 4); 2A ­ 44% (n = 21); 2B – 39% (n = 18); 3A – 8.5% (n = 4); 78.5% of patients received anticoagulants. Patients with comorbidities were distributed as follows: diabetes mellitus – 38.7%; hypertension – 85.3%; history of cerebrovascular disorders – 64.7%; AFib arrhythmias – 42.4%. The severity of viral pneumonia according to CT: CT1 – 12% (n = 6), CT2 – 19% (n = 9), CT3 – 29% (n = 14), CT4 – 21% (n = 10), CT was not performed – 19% (n = 8 because of the condition severity). Patients were grouped by intervention type: selective thrombolysis – 9%, surgical thrombectomy – 10%, endovascular interventions – 63%, hybrid interventions – 18%. Clinical outcomes (all­cause mortality, major cardiovascular events, repeat revascularization) were retrospectively evaluated. Using regression analysis, we found a correlation between the end­point and the severity of the underlying disease, assessed predictors of adverse outcomes, and constructed a prognostic model. Complications were also evaluated; according to our data, three patients had early thrombosis in their reconstruction zones and two patients had technical failures of revascularization of their lower leg and foot arteries. In­hospital mortality was 65.3%. Conclusion. Our prognostic model allowed to find a correlation between clinical and laboratory data and the end­point. Keywords: revascularization, SARS-­Cov­-2, thrombosis, acute ischemia, thrombotic events, endovascular interventions