Related Experiment Video
Updated: Sep 1, 2025
High-Resolution Three-Dimensional Imaging of the Footpad Vasculature in a Murine Hindlimb Gangrene Model
Published on: March 16, 2022
Outcomes of acute limb ischemia in COVID-19
Antoine Pham1, Adele Heib1, Emily Goodman1
1Department of Vascular and Endovascular Surgery, Albert Einstein College of Medicine and Montefiore Medical Center, Bronx, NY.
Insights
Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection can lead to acute limb ischemia (ALI), resulting in higher mortality and adverse events. Patients with COVID-19 and ALI face worse outcomes compared to those without ALI.
Area of Science:
- Vascular Surgery
- Infectious Diseases
- Critical Care Medicine
Background:
- Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection is associated with a pro-thrombotic state.
- Acute limb ischemia (ALI) is a severe complication that can arise from arterial thrombosis.
- The impact of coronavirus disease 2019 (COVID-19) on ALI outcomes requires further investigation.
Purpose of the Study:
- To compare the outcomes of ALI in patients with and without COVID-19.
- To determine if ALI development in the context of COVID-19 is associated with a worse prognosis.
- To analyze demographic and comorbidity differences between ALI patients with and without COVID-19.
Main Methods:
- Utilized TriNetX, a federated health data network, for de-identified patient data.
- Identified patients with ALI and COVID-19 using International Classification of Diseases, 10th revision codes.
- Employed propensity-score matching to compare outcomes including mortality, major adverse limb events, and acute renal failure.
Main Results:
- Patients with ALI and COVID-19 (ALI C19+) had fewer baseline comorbidities than ALI patients without COVID-19.
- ALI C19+ patients exhibited significantly higher rates of mortality, major adverse limb events, and acute renal failure compared to ALI patients.
- ALI C19+ patients showed increased rates of respiratory failure, sepsis, acute renal failure, and mortality compared to COVID-19 patients without ALI.
Conclusions:
- COVID-19 patients who develop ALI have distinct demographic and comorbidity profiles.
- COVID-19 may precipitate ALI and worsen its sequelae, leading to increased adverse events and mortality.
- Development of ALI in COVID-19 patients indicates a poorer prognosis.
Objective:
The inflammatory cascade caused by severe acute respiratory syndrome coronavirus 2 infection may result in arterial thrombosis and acute limb ischemia (ALI) with devastating consequences. The aims of this study were to compare outcomes of ALI in the lower extremities in patients with and without coronavirus disease 2019 (COVID-19), and to determine if ALI development in the context of COVID-19 portends a worse prognosis compared with COVID-19 without ALI.
Methods:
Queries were built on TriNetX, a federated network of health care organizations across the United States that provides de-identified patient data. International Classification of Diseases, 10th revision diagnostic codes were used to identify patients with acute limb ischemia of the lower extremities and COVID-19. The study timeframe was defined as January 20, 2020 to May 20, 2021. Statistical analyses, including propensity-score matching, were done through TriNetX's internal software. Outcomes looked at are rates of mortality, stroke, myocardial infarction, major adverse limb events, re-intervention, respiratory failure, sepsis, mental health complications, and acute renal failure. Baseline cohort characteristics were also collected.
Results:
Patients with ALI with COVID-19 (ALI C19+; n = 526) were significantly less likely than patients with ALI without COVID-19 (ALI; n = 14,131) to have baseline comorbidities, including nicotine dependence (18% vs 33%; P < .0001). In contrast, ALI C19+ patients had significantly more comorbidities than hospitalized patients with COVID-19 without ALI (n = 275,903), including nicotine dependence (18% vs 10%; P < .0001). After propensity matching was performed, ALI C19+ patients had significantly higher rates of mortality (24.9% vs 9.2%; P < .0001), major adverse limb events (5.8% vs 2.9%; P = .0223), and acute renal failure (22.2% vs 14.9%; P = .0025) than patients with ALI. Compared with hospitalized patients with COVID-19 without ALI, ALI C19+ patients had higher propensity-matched rates of respiratory failure and being placed on assisted ventilation (32.9% vs 27%; P = .0369), sepsis (16.9% vs 12.2%; P = .0288), acute renal failure (22.1% vs 14.6%; P = .0019), and mortality (24.7% vs 14.4%; P < .0001).
Conclusions:
Patients who developed ALI following COVID-19 present with significantly different demographics and comorbidities from those who develop ALI without COVID-19. After controlling for these variables, higher rates of major adverse limb events, acute renal failure, and mortality in patients with ALI with COVID-19 suggest that not only may COVID-19 precipitate ALI, but it may also exacerbate ALI sequelae. Furthermore, development of ALI in COVID-19 portends worse prognosis compared with patients with COVID-19 without ALI.
Related Concept Videos
01:19Acute Coronary Syndrome II: Pathophysiology and Clinical Manifestations
01:30Acute Coronary Syndrome I: Introduction
01:28Acute Coronary Syndrome IV: Interprofessional Care
01:23Peripheral Artery Disease V: Postoperative Nursing Management
01:26Acute Coronary Syndrome V: Nursing Management
01:17Ischemic Heart Disease: Overview
Atherosclerosis, the primary malefactor, orchestrates this dangerous condition. It manifests as the accumulation of fatty deposits, akin to insidious plaques, within arterial walls. As time elapses, these plaques metamorphose, hardening and...