Abstract 4367410: Association Between COVID-19 and In-Hospital Mortality in Patients with Peripheral Arterial Disease and Acute Limb Ischemia: Analysis of National Inpatient Sample (2020-2022)

Introduction: Peripheral arterial disease (PAD) complicated by acute limb ischemia (ALI) is a vascular emergency. The emergence of COVID-19, with its known prothrombotic effects, has raised the likelihood of worse vascular outcomes in this vulnerable cohort. This study aims to evaluate how concurrent infection with COVID-19 impacts in-hospital mortality among patients hospitalized with both PAD and ALI using a nationally representative database. Methods: We used the HCUP-NIS dataset (2020–2022) to identify adult hospitalizations with both peripheral arterial disease and acute limb ischemia using ICD-10 codes. COVID-19 status and in-hospital mortality were recorded. Survey-weighted logistic regression was used to adjust for age, sex, race, income, and Charlson Comorbidity Index (CCI). Results: 14,959 patients were admitted with ALI and PAD. Out of this 789 had COVID-19 (5.27%) and the remaining 14,170 (94.73%) were negative. In-hospital mortality was 27.76% in patients with COVID-19 compared to 6.37% in COVID negative patients (p < 0.001). After adjusting for age, race, sex, income, and comorbidity burden using the CCI, COVID-19 remained a strong independent predictor of in-hospital death (p < 0.001). Increasing age and higher CCI scores were also independently associated with mortality. We evaluated calendar-year trends in in-hospital mortality among patients with PAD, ALI, and concurrent COVID-19 infection from 2020 to 2022. After adjusting for co-variates, there was no statistically significant difference in mortality across the three years. Compared to 2020, the adjusted odds of in-hospital death were not significantly different in 2021 (p = 0.959) or in 2022 (p = 0.256).