The catastrophic impact of Covid-19 infection in patients with Chronic Limb Threatening Ischaemia

de Athayde Soares, Rafael; de Arruda Cáceres, Nayara; Barbosa, Anndya Gonçalves; Matielo, Marcelo Fernando; Sacilotto, Roberto

OBJECTIVE: To determine the impact of COVID-19 infection in patients with chronic limb threatening ischemia (CLTI), mainly the limb salvage estimates rate and the overall survival rate. METHODS: This was a retrospective, consecutive cohort study of CLTI patients with COVID-19 infection. RESULTS: Overall, 35 patients with CLTI and COVID-19 infection were evaluated. The mean age of the patients was 72,51 years, and most of them were male (60%), with arterial hypertension (85.7%), followed by diabetes mellitus (80%) and tobacco user (71.4%). There was a higher prevalence of WIfI classification 3 with 58.8% and Rutherford grade 5 (74.3%). The factors related to overall mortality rate were: D-dimer > 1000mg/dl (HR = 22.7, p < 0.001, CI = 10.49-26.52), respiratory symptoms (HR = 16.6, p < 0.001, CI = 9.87 – 20.90), CT-Chest compromising higher than 50% of the pulmonary tract (HR = 16,0, p < 0.001, CI = 10.41-20.55), acute kidney failure (AKF) (HR = 21.58, p < 0.001, CI = 16.5-30.5), chronic kidney disease (CKD) (HR = 4.4, p = 0.036, CI = 1.45-10.1), therapeutic anticoagulation (TA) (HR = 8.37, p = 0.004, CI = 1.35-8.35) and WIfI classification (HR = 5.28, p = 0.022, CI = 1.34-10.01). The following were related to limb loss: d-Dimer > 1000mg/ml (HR = 5.47, p = 0.02, CI = 1.94-10.52), respiratory symptoms (HR = 5.42, p = 0.02, CI = 1.87-10.90) and WIfI classification (HR = 4.44, p = 0.035, CI = 1.34-8.01). CONCLUSION: This study concluded that COVID-19 has a catastrophic impact among patients with CLTI. The main factors related to overall mortality were D-dimer > 1000mg/dl, respiratory symptoms, CT-Chest compromising higher than 50% of the pulmonary tract, AKF, CKD, TA and WIfI classification. The factors related to limb loss were WIfI classification, d-Dimer > 1000mg/ml and respiratory symptoms.