新冠时期的急性动脉闭塞：伴有或不伴有新冠感染的急性肢体缺血患者的对比研究。
Acute Arterial Occlusions in COVID-19 Times: A Comparison Study Among Patients with Acute Limb Ischemia With or Without COVID-19 Infection.
机构信息
Division of Vascular and Endovascular Surgery, Hospital do Servidor Público Estadual de São Paulo, São Paulo, Brazil.
Division of Vascular and Endovascular Surgery, Hospital do Servidor Público Estadual de São Paulo, São Paulo, Brazil.
出版信息
Ann Vasc Surg. 2022 Jul;83:80-86. doi: 10.1016/j.avsg.2022.04.006. Epub 2022 Apr 20.
BACKGROUND
To determine the impact of coronavirus (COVID-19) infection in patients with acute limb ischemia (ALI), mainly the limb salvage estimates the rate and the overall survival rate.
METHODS
This was a prospective, consecutive cohort study of ALI patients with or without COVID-19 infection. Two groups of patients were identified: patients with ALI and COVID-19 infection and patients with ALI and without COVID-19 infection. The comparisons among the 2 groups were performed with proper statistical analysis methods.
RESULTS
Two groups of patients were identified: ALI and COVID-19 infection with 23 patients and ALI without COVID-19 infection with 49 patients. The overall mortality rate (OMR) was 20.8% (15 patients) in total cohort within the first 30 days. COVID-19 group had a higher OMR than non-COVID-19 group (30.4% vs. 16.7%, P = 0.04). The limb salvage rate at 30 days was 79.1% in total cohort; however, non-COVID-19 infection group had higher limb salvage rates than COVID-19 infection group (89.7% vs. 60.8%, P = 0.01). A univariate and multivariate logistic regression was performed to test the factors related to a major amputation rate. Among the factors evaluated, the following were related to limb loss: D-dimer > 1,000 mg/mL (hazards ratio [HR] = 3.76, P = 0.027, CI = 1.85-5.89) and COVID-19 infection (HR = 1.38, P = 0.035, CI = 1.03-4.75). Moreover, a univariate and multivariate logistic regression analysis was performed to analyze the factors related to overall mortality. Among the factors evaluated, the following were related to OMR: D-dimer > 1,000 mg/dL (HR = 2.28, P = 0.038, CI: 1.94-6.52), COVID-19 infection (HR = 1.8, P = 0.018, CI = 1.01-4.01), and pharmacomechanical thrombectomy >150 cycles (HR = 2.01, P = 0.002, CI = 1.005-6.781).
CONCLUSIONS
COVID-19 has a worse prognosis among patients with ALI, with higher rates of limb loss and overall mortality relative to non-COVID patients. The main factors related to overall mortality were D-dimer > 1,000 mg/dL, COVID-19 infection, and pharmacomechanical thrombectomy >150 cycles. The factors related to limb loss were D-dimer > 1,000 mg/mL and COVID-19 infection.
背景
为了确定冠状病毒（COVID-19）感染对急性肢体缺血（ALI）患者的影响，主要是评估肢体存活率和总体存活率。
方法
这是一项前瞻性、连续队列研究，纳入了有或没有 COVID-19 感染的 ALI 患者。确定了两组患者：有 COVID-19 感染的 ALI 患者和没有 COVID-19 感染的 ALI 患者。通过适当的统计分析方法对两组进行了比较。
结果
确定了两组患者：有 COVID-19 感染的 ALI 患者 23 例，没有 COVID-19 感染的 ALI 患者 49 例。在最初 30 天内，总队列的总体死亡率（OMR）为 20.8%（15 例）。COVID-19 组的 OMR 高于非 COVID-19 组（30.4%对 16.7%，P=0.04）。总队列中 30 天的肢体存活率为 79.1%；然而，非 COVID-19 感染组的肢体存活率高于 COVID-19 感染组（89.7%对 60.8%，P=0.01）。进行了单变量和多变量逻辑回归以检验与主要截肢率相关的因素。在评估的因素中，以下因素与肢体丧失有关：D-二聚体>1000mg/mL（危险比[HR]3.76，P=0.027，CI 1.85-5.89）和 COVID-19 感染（HR 1.38，P=0.035，CI 1.03-4.75）。此外，还进行了单变量和多变量逻辑回归分析，以分析与总体死亡率相关的因素。在评估的因素中，以下因素与 OMR 有关：D-二聚体>1000mg/dL（HR 2.28，P=0.038，CI 1.94-6.52）、COVID-19 感染（HR 1.8，P=0.018，CI 1.01-4.01）和机械血栓切除术>150 次（HR 2.01，P=0.002，CI 1.005-6.781）。
结论
COVID-19 患者的 ALI 预后较差，与非 COVID 患者相比，肢体丧失率和总体死亡率更高。与总体死亡率相关的主要因素是 D-二聚体>1000mg/dL、COVID-19 感染和机械血栓切除术>150 次。与肢体丧失相关的因素是 D-二聚体>1000mg/mL 和 COVID-19 感染。
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