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

Abstract 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.