Incidence, Characteristics, Laboratory Findings and Outcomes in Acro-Ischemia in COVID-19 Patients

Figures & data

Figure 1 Clinical patterns of acroischemia. Upper: Outpatients (ARP and PP). Lower: Hospitalized patients (SMI and AO).

Table 1 Demographic Characteristics of Patients with COVID-19 Infection and Acro-Ischemia

Demographic Characteristics	Atypical Raynaud Phenomenon (n=4)	Pseudo-Pernio (n=5)	Severe Microcirculatory Ischemia with Preserved Pulse (n=6)	Dry Gangrene with Arteriosclerosis Obliterans (n=9)
Age; yr (mean±standard deviation)	45±5	44±25	78±19	70±10
Race (caucasian:hispanic)	4:0	5:0	5:1	9:0
Sex (female:male)	3:1	2:3	0:6	2:7
Covid-19 environment (%)
Health workers	3/4	3/5	UK	UK
Nursing home	–	1/5	UK	UK
Other	1/4	1/5	UK	UK
Number of tests done:positive results
PCR	4:2	5:3	6:5	9:8
Serological	2:0	1:0	–	–
CV risk factor (%, count)
Tobacco use	0	0	17 (n=1)	44 (n=4)
HBP	25 (n=1)	20 (n=1)	83 (n=5)	89 (n=8)
Obesity	0	0	17 (n=1)	78 (n=7)
Dyslipidemia	0	20 (n=1)	50 (n=3)	67 (n=6)
Diabetes mellitus	0	0	17 (n=1)	67 (n=6)
COPD	0	0	33 (n=2)	11 (n=1)
Medical history (%)	0	0	17	22
Cancer	0	0	17	22
Venous thromboembolism	0	0	33	0
Cardiovascular disease	0	0	50	55
Cerebrovascular disease	0	0	0	11
Autoimmune disease	0	0	0	0
Charlson comorbidity index (%)
0–1	–	–	67	22
≤ 2	–	–	0	55
> 3	–	–	33	22
Previous treatment (%)
ACE inhibitor	25	20	83	89
Statin	0	20	50	67
Antiplatelet	0	0	33	55
Anticoagulant	0	0	33	11

Abbreviations: ACE, angiotensin converting enzyme; COPD, chronic obstructive pulmonary disease; CV, cardiovascular; HBP, hypertension; PCR, polymerase chain reaction; UK, unknown.

Table 2 Clinical Characteristics of Patients with COVID-19 Infection and Acro-Ischemia (I)

Clinical Characteristics	Atypical Raynaud Phenomenon (n=4)	Pseudo-Pernio (n=5)	Severe Microcirculatory Ischemia with Preserve Pulse (n=6)	Dry Gangrene with Arteriosclerosis Obliterans (n=9)
Type of patient
Outpatients	4	5	0	0
Hospital: ward	0	0	6	1
Hospital: critical care	0	0	0	8
Covid-19 symptoms (%)
Fever	100	100	100	100
Malaise	100	100	100	100
Cough	100	100	100	100
Diarrhea	75	100	100	100
Headache	100	80	100	100
Hyposmia	50	0	50	55
Dysgeusia	50	40	50	67
Others symptoms (%)
Arthralgia	25	40	50	55
Loin pain	50	0	0	0
Otalgia	25	0	0	0
Lymphadenopathy	25	20	0	0
Genitalia (ulcer)	25	0	0	0
Viral pneumonia (%)	0	0	100	100
Disease severity (%)
Mild	100	100	–	–
Moderate	–	–	33	–
Severe	–	–	67	100
CURB-65 score 2 (%)			67	77
SaO2/FiO2	–	–	>140	<140
Covid-19 treatment (%)
Hydroxychloroquine	–	–	100	100
Lopinavir/Ritonavir	–	–	67	77
Interferon	–	–	50	77
Glucocorticoids	–	–	83	55
Tocilizumab	–	–	–	22
Cyclosporine	–	–	–	22
Colchicine	–	–	–	11
LMWH before skin event (%)
Prophylactic doses	–	–	50	44
Medium doses	–	–	16,7	22
High doses	–	–	33	33
Skin event treatment (%)
Antiplatelet	25	20	17	22
Anticoagulant	0	0	100	100
Statin	0	40	17	22

Table 3 Clinical Characteristics of Patients with COVID-19 Infection and Acro-Ischemia (II)

Clinical Characteristics	Atypical Raynaud Phenomenon (n=4)	Pseudo-Pernio (n=5)	Severe Microcirculatory Ischemia with Preserve Pulse (n=6)	Dry Gangrene with Arteriosclerosis Obliterans (n=9)
Days from disease onset to vascular skin event (mean-range)	13 (10–14)	13 (10–14)	20 (6–24)	14 (11–18)
Skin lesions duration (mean-range)	15 minutes pulses (7–14)	10 days (2–14)	28 days (21–59)	unresolved
Other vascular skin lesions (%)
Splinter hemorrhage	–	–	17	–
Livedo racemosa	–	–	–	33
Ischemic events (%)
Cardiac	–	–	17	44
Brain	–	–	67	22
Retina	–	20	–	–
Spleen	–	–	–	11
Gut	–	–	–	22
Nerve	–	–	–	22
Acute kidney injury (%)	–	–	0	100
Liver failure (%)	–	–	0	33
VTE (%)	–	–	0	22
Atrial fibrillation (%)	–	–	33	22
Syncope (%)	–	–	50	44
Bacterial superinfection (%)	–	–	0	44
SOFA	0	0	≤ 2	>2
Exitus (%)	–	–	17	67
Discharged (%)	–	–	67	11
Readmission (%)	–	–	0	0
Follow-up, days (mean-range)	38 (21–63)	19 (11–24)	44 (15–59)	54 (2–90)

Figure 2 Fundus autofluorescence: abnormalities in branches of central retinal artery.

Figure 3 MRI: femoral condyle ischemia.

Figure 4 CT-scan: Thalamic infarct.

Figure 5 ^99mTc macroaggregated albumin pulmonary perfusion scan: change in regional pulmonary perfusion as a result of posture. Lower lobes are affected by gravity.

A: supine; B: sitting.

Figure 6 Pathophysiological hypothesis and clinical-demographic phenotypes of COVID-19 infection. CVRF: Cardiovascular Risk Factors.

Abbreviations: AP, arterial pressure; PRP, pulmonary Raynaud´s phenomenon.