The Impact of COVID-19 on Amputation and Mortality Rates in Patients with Acute Limb Ischemia: A Systematic Review...

Area of Science:

• Vascular Surgery
• Infectious Diseases
• Critical Care Medicine

Background:

• The COVID-19 pandemic has been associated with an increased incidence of Acute Limb Ischemia (ALI).
• Evidence suggests COVID-19 infection may worsen ALI prognosis, yet direct comparative outcome studies are limited.
• Understanding these differences is crucial for patient management and resource allocation.

Purpose of the Study:

• To systematically review and meta-analyze the literature comparing outcomes in COVID-19 positive versus negative ALI patients.
• To evaluate differences in amputation and mortality rates between these two groups.
• To provide a quantitative assessment of the impact of COVID-19 on ALI prognosis.

Main Methods:

• A systematic literature search was conducted across PubMed (MEDLINE), Web of Science, and Embase (OVID) databases.
• Studies published from January 2020 to December 2023 were screened, recovering 7906 articles.
• 11 studies (n: 15,803 subjects) were included for systematic review, with 10 (15,305 patients) used for meta-analysis.

Main Results:

• COVID-19 positive ALI patients exhibited higher mortality rates (6.7%–47.2%) and amputation rates (7.0%–39.1%) compared to non-infected ALI patients (mortality 3.1%–16.7%; amputation 2.7%–18%).
• Meta-analysis confirmed significantly higher amputation rates (OR: 2.31) and mortality (OR: 3.64) in COVID-19 ALI patients.
• Statistical significance was robust, with p-values < 0.00001 for both outcomes.

Conclusions:

• COVID-19 infection is associated with significantly worse outcomes in patients with Acute Limb Ischemia.
• Both amputation and mortality rates are substantially elevated in ALI patients with concurrent COVID-19 infection.
• These findings underscore the importance of considering COVID-19 status in the management and prognosis of ALI.