Calcification of the thoracic aorta on low-dose chest CT predicts severe COVID-19

Background Cardiovascular comorbidity anticipates poor prognosis of SARS-CoV-2 disease (COVID-19) and correlates with the systemic atherosclerotic transformation of the arterial vessels. The amount of aortic wall calcification (AWC) can be estimated on low-dose chest CT. We suggest quantification of AWC on the low-dose chest CT, which is initially performed for the diagnosis of COVID-19, to screen for patients at risk of severe COVID-19. Methods Seventy consecutive patients (46 in center 1, 24 in center 2) with parallel low-dose chest CT and positive RT-PCR for SARS-CoV-2 were included in our multi-center, multi-vendor study. The outcome was rated moderate (no hospitalization, hospitalization) and severe (ICU, tracheal intubation, death), the latter implying a requirement for intensive care treatment. The amount of AWC was quantified with the CT vendor's software. Results Of 70 included patients, 38 developed a moderate, and 32 a severe COVID-19. The average volume of AWC was significantly higher throughout the subgroup with severe COVID-19, when compared to moderate cases (771.7 mm3 (Q1 = 49.8 mm3, Q3 = 3065.5 mm3) vs. 0 mm3 (Q1 = 0 mm3, Q3 = 57.3 mm3)). Within multivariate regression analysis, including AWC, patient age and sex, as well as a cardiovascular comorbidity score, the volume of AWC was the only significant regressor for severe COVID-19 (p = 0.004). For AWC > 3000 mm3, the logistic regression predicts risk for a severe progression of 0.78. If there are no visually detectable AWC risk for severe progression is 0.13, only. Conclusion AWC seems to be an independent biomarker for the prediction of severe progression and intensive care treatment of COVID-19 already at the time of patient admission to the hospital; verification in a larger multi-center, multi-vendor study is desired.

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Coronary artery calcification on low-dose chest CT is an early predictor of severe progression of COVID-19—A multi-center, multi-vendor study

PLoS ONE ◽

10.1371/journal.pone.0255045 ◽

2021 ◽

Vol 16 (7) ◽

pp. e0255045

Author(s):

Philipp Fervers ◽

Jonathan Kottlors ◽

Nils Große Hokamp ◽

Johannes Bremm ◽

David Maintz ◽

...

Keyword(s):

Intensive Care ◽

Coronary Artery ◽

Primary Endpoint ◽

Coronary Artery Calcification ◽

Low Dose ◽

Interquartile Range ◽

Agatston Score ◽

Intensive Care Treatment ◽

Clinical Predictors ◽

Care Treatment

Purpose Cardiovascular comorbidity anticipates severe progression of COVID-19 and becomes evident by coronary artery calcification (CAC) on low-dose chest computed tomography (LDCT). The purpose of this study was to predict a patient’s obligation of intensive care treatment by evaluating the coronary calcium burden on the initial diagnostic LDCT. Methods Eighty-nine consecutive patients with parallel LDCT and positive RT-PCR for SARS-CoV-2 were included from three centers. The primary endpoint was admission to ICU, tracheal intubation, or death in the 22-day follow-up period. CAC burden was represented by the Agatston score. Multivariate logistic regression was modeled for prediction of the primary endpoint by the independent variables “Agatston score > 0”, as well as the CT lung involvement score, patient sex, age, clinical predictors of severe COVID-19 progression (history of hypertension, diabetes, prior cardiovascular event, active smoking, or hyperlipidemia), and laboratory parameters (creatinine, C-reactive protein, leucocyte, as well as thrombocyte counts, relative lymphocyte count, d-dimer, and lactate dehydrogenase levels). Results After excluding multicollinearity, “Agatston score >0” was an independent regressor within multivariate analysis for prediction of the primary endpoint (p<0.01). Further independent regressors were creatinine (p = 0.02) and leucocyte count (p = 0.04). The Agatston score was significantly higher for COVID-19 cases which completed the primary endpoint (64.2 [interquartile range 1.7–409.4] vs. 0 [interquartile range 0–0]). Conclusion CAC scoring on LDCT might help to predict future obligation of intensive care treatment at the day of patient admission to the hospital.

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Prolonged intensive care treatment of octogenarians after cardiac surgery: Is the economic burden justified?

The Thoracic and Cardiovascular Surgeon ◽

10.1055/s-0031-1297792 ◽

2012 ◽

Vol 60 (S 01) ◽

Author(s):

H Deschka ◽

L Vöhringer ◽

J Neufeld ◽

G Wimmer-Greinecker

Keyword(s):

Cardiac Surgery ◽

Intensive Care ◽

Economic Burden ◽

Intensive Care Treatment ◽

Care Treatment

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The presence of liver cirrhosis is a strong negative predictor of survival for patients admitted to the intensive care unit – Cirrhosis in intensive care patients

Zeitschrift für Gastroenterologie ◽

10.1055/a-1401-2387 ◽

2021 ◽

Author(s):

Jörg Bojunga ◽

Mireen Friedrich-Rust ◽

Alica Kubesch ◽

Kai Henrik Peiffer ◽

Hannes Abramowski ◽

...

Keyword(s):

Intensive Care Unit ◽

Liver Cirrhosis ◽

Intensive Care ◽

Hospital Mortality ◽

Intensive Care Treatment ◽

Matched Cohort ◽

Care Treatment ◽

Cirrhotic Patients ◽

The Impact ◽

Cirrhotic Group

Abstract Background and Aims Liver cirrhosis is a systemic disease that substantially impacts the body’s physiology, especially in advanced stages. Accordingly, the outcome of patients with cirrhosis requiring intensive care treatment is poor. We aimed to analyze the impact of cirrhosis on mortality of intensive care unit (ICU) patients compared to other frequent chronic diseases and conditions. Methods In this retrospective study, patients admitted over three years to the ICU of the Department of Medicine of the University Hospital Frankfurt were included. Patients were matched for age, gender, pre-existing conditions, simplified acute physiology score (SAPS II), and therapeutic intervention scoring system (TISS). Results A total of 567 patients admitted to the ICU were included in the study; 99 (17.5 %) patients had liver cirrhosis. A total of 129 patients were included in the matched cohort for the sensitivity analysis. In-hospital mortality was higher in cirrhotic patients than non-cirrhotic patients (p < 0.0001) in the entire and matched cohort. Liver cirrhosis remained one of the strongest independent predictors of in-hospital mortality (entire cohort p = 0.001; matched cohort p = 0.03) along with dialysis and need for transfusion in the multivariate logistic regression analysis. Furthermore, in the cirrhotic group, the need for kidney replacement therapy (p < 0.001) and blood transfusion (p < 0.001) was significantly higher than in the non-cirrhotic group. Conclusions In the presented study, liver cirrhosis was one of the strongest predictors of in-hospital mortality in patients needing intensive care treatment along with dialysis and the need for ventilation. Therefore, concerted efforts are needed to improve cirrhotic patients’ outcomes, prevent disease progression, and avoid complications with the need for ICU treatment in the early stages of the disease.

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