Risk Factors Associated with In-hospital Poor Outcomes in Patients with Acute Limb Ischemia


Author(s):

Emil Marian Arbănași¹,²,³,⁴, Mircea Cătălin Coșarcă²,⁵,*, Alexandru Mureșan², Eliza Mihaela Arbănași³,⁴, Nicoale Alexandru Lazăr², Ionela Georgiana Bodiu², Maria Teodora Constantin⁶, Réka Bartus¹,², Ludovic Alexandru Szanto², Bogdan Corneliu Bandici², Adrian Vasile Mureșan¹,², Eliza Russu¹,²

Affiliation:

¹ Department of Vascular Surgery, George Emil Palade University of Medicine, Pharmacy, Science and Technology, Târgu Mureș, Romania
² Clinic of Vascular Surgery, Mures County Emergency Hospital, Târgu Mureș, Romania
³ Doctoral School of Medicine and Pharmacy, George Emil Palade University of Medicine, Pharmacy, Science and Technology, Târgu Mureș, Romania
⁴ Regenerative Medicine Laboratory, Centre for Advanced Medical and Pharmaceutical Research (CCAMF), George Emil Palade University of Medicine, Pharmacy, Science and Technology, Târgu Mureș, Romania
⁵ Department of Anatomy, George Emil Palade University of Medicine, Pharmacy, Science and Technology, Târgu Mureș, Romania
⁶ Faculty of Military Medicine, George Emil Palade University of Medicine, Pharmacy, Science and Technology, Târgu Mureș, Romania

DOI: 10.2478/jce-2025-0008

Background: Acute limb ischemia (ALI) is a vascular emergency characterized by a sudden reduction in limb perfusion, most commonly resulting from thromboembolism or thrombosis at the site of an atherosclerotic plaque. This study aimed to analyze and identify risk factors associated with major amputation and in-hospital mortality in patients with ALI. Material and methods: We retrospectively analyzed 177 patients diagnosed with upper or lower limb ALI admitted to the Vascular Surgery Clinic between January 2019 and December 2024. Data collected from electronic medical records included demographic variables, cardiovascular comorbidities, chronic kidney disease, diabetes mellitus, malignancies, preoperative laboratory parameters (within the first 12 h of admission), type of surgical intervention, and anesthesia type. Results: Patients with lower limb ischemia were significantly older than those with upper limb involvement (p = 0.041). Lower limb ischemia was also associated with a higher prevalence of ischemic heart disease (p = 0.030), chronic heart failure (p = 0.013), and peripheral arterial disease (p < 0.001). Laboratory findings revealed lower red blood cell counts (p = 0.034), hemoglobin (p = 0.010), and hematocrit (p = 0.011), along with higher creatine kinase (p = 0.013), neutrophil (p = 0.017), and monocyte levels (p = 0.034) in patients with lower limb ALI. While surgical intervention types did not differ significantly, lower limb ALI patients underwent local anesthesia less frequently (p < 0.001) and general anesthesia more frequently (p < 0.001). Univariate analysis identified peripheral arterial disease (OR: 2.45, p = 0.046) as a predictor of major amputation, while chronic heart failure (OR: 2.77, p = 0.033), prior myocardial infarction (OR: 3.85, p = 0.024), and diabetes mellitus (OR: 3.23, p = 0.012) were significantly associated with in-hospital mortality. Conclusions: These findings highlight the critical role of aggressive cardiovascular risk factor management in patients with ALI to improve outcomes following surgical revascularization.