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Clinical course of patients with chronic limb-threatening ischemia developing COVID-19
Takayuki Ishihara1, Osamu Iida1, Mitsuyoshi Takahara2
1Kansai Rosai Hospital Cardiovascular Center, Amagasaki, Japan.
Insights
COVID-19 significantly increases mortality risk in patients with chronic limb-threatening ischemia (CLTI). This study found a 20% 30-day mortality rate in CLTI patients with COVID-19, highlighting the need for protective measures.
Area of Science:
- Vascular Surgery
- Infectious Diseases
- Public Health
Background:
- The COVID-19 pandemic has strained healthcare systems globally.
- Patients with chronic limb-threatening ischemia (CLTI), a severe form of peripheral artery disease, face elevated cardiovascular event and mortality risks.
- The clinical impact of COVID-19 on CLTI patients remains underreported.
Purpose of the Study:
- To investigate the clinical course and outcomes of CLTI patients diagnosed with COVID-19.
- To compare the mortality risk of CLTI patients with COVID-19 against a pre-pandemic cohort.
Main Methods:
- Retrospective analysis of 25 CLTI patients with COVID-19 during Japan's "sixth wave" (January 2022).
- Primary outcome: 30-day mortality post-COVID-19 diagnosis.
- Comparison with 1867 CLTI patients treated pre-pandemic using Cox proportional hazard regression and inverse probability weighting (IPW).
Main Results:
- The 30-day mortality rate for CLTI patients with COVID-19 was 20% (95% CI: 7%-41%).
- Cox regression revealed a significantly higher mortality risk in COVID-19 positive CLTI patients (adjusted hazard ratio: 3.08).
- IPW analysis confirmed a significant association between COVID-19 and increased mortality risk (hazard ratio: 3.97).
Conclusions:
- COVID-19 diagnosis in CLTI patients is associated with a substantially increased 30-day mortality risk.
- The findings underscore the vulnerability of CLTI patients to severe outcomes from COVID-19 infection.
- This highlights the critical need for vigilant monitoring and protective strategies for this high-risk population during pandemics.
Background:
The COVID-19 pandemic, caused by severe acute respiratory syndrome coronavirus 2, has overwhelmed healthcare systems. Patients with lower extremity artery disease are at high risk of cardiovascular events, of whom chronic limb-threatening ischemia (CLTI) is the most severe manifestation of peripheral artery disease with an increased risk of mortality compared to patients with intermittent claudication. However, the clinical course of CLTI patients with COVID-19 has not been reported.
Methods:
We retrospectively surveyed clinical course for 25 CLTI patients who developed COVID-19 during the "sixth wave" of the pandemic in Japan, which started in January 2022. The primary outcome measure was the 30-day mortality after the diagnosis of COVID-19. We also compared the mortality risk of the 18 COVID-19 patients who underwent initial endovascular treatment with that of 1867 CLTI patients who received initial endovascular treatment before December 2019 (i.e. before the COVID-19 pandemic) (control group). Cox proportional hazard regression model was used to evaluate the effect of COVID-19 on the mortality. To confirm the robustness of these results, we added the analysis with inverse probability weighting (IPW) based on the propensity score for the COVID-19.
Results:
The 30-day mortality after the diagnosis of COVID-19 reached 20 %; the 95 % confidence interval (CI) of the proportion was calculated to be 7 % to 41 % by the Clopper-Pearson exact method. Cox regression analysis demonstrated the mortality risk was significantly higher in patients developing COVID-19 than in control group [adjusted hazard ratio, 3.08 (95 % CI, 1.13-8.37); p = 0.027]. The IPW analysis also confirmed the significant association of COVID-19 with the mortality risk [hazard ratio, 3.97 (95 % CI 1.54-10.21, p = 0.004)].
Conclusion:
In CLTI patients, the 30-day mortality after the diagnosis of COVID-19 reached 20 % (95 % CI, 7 % to 41 %) under the pandemic in January 2022, and patients developing COVID-19 had a significantly higher mortality risk than those treated before the pandemic.
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