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

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.

Download Full-text

Reliable categorisation of visual scoring of coronary artery calcification on low-dose CT for lung cancer screening: validation with the standard Agatston score

European Radiology ◽

10.1007/s00330-012-2726-5 ◽

2012 ◽

Vol 23 (5) ◽

pp. 1226-1233 ◽

Cited By ~ 10

Author(s):

Yi-Luan Huang ◽

Fu-Zong Wu ◽

Yen-Chi Wang ◽

Yu-Jeng Ju ◽

Guang-Yuan Mar ◽

...

Keyword(s):

Lung Cancer ◽

Coronary Artery ◽

Cancer Screening ◽

Coronary Artery Calcification ◽

Low Dose ◽

Lung Cancer Screening ◽

Agatston Score ◽

Low Dose Ct ◽

Visual Scoring

Download Full-text

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

PLoS ONE ◽

10.1371/journal.pone.0244267 ◽

2020 ◽

Vol 15 (12) ◽

pp. e0244267

Author(s):

Philipp Fervers ◽

Jonathan Kottlors ◽

David Zopfs ◽

Johannes Bremm ◽

David Maintz ◽

...

Keyword(s):

Intensive Care ◽

Low Dose ◽

Multivariate Regression Analysis ◽

Chest Ct ◽

Intensive Care Treatment ◽

Rt Pcr ◽

Cardiovascular Comorbidity ◽

Care Treatment ◽

Wall Calcification ◽

Patients At Risk

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.

Download Full-text

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

Download Full-text

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.

Download Full-text

Burn intensive care treatment over the last 30 years: Improved survival and shift in case-mix

Burns ◽

10.1016/j.burns.2019.02.005 ◽

2019 ◽

Vol 45 (5) ◽

pp. 1057-1065

Author(s):

Rolf K. Gigengack ◽

Margriet E. van Baar ◽

Berry I. Cleffken ◽

Jan Dokter ◽

Cornelis H. van der Vlies

Keyword(s):

Intensive Care ◽

Case Mix ◽

Intensive Care Treatment ◽

Care Treatment

Download Full-text

Plasma F2-Isoprostanes and Coronary Artery Calcification: The CARDIA Study

Clinical Chemistry ◽

10.1373/clinchem.2004.037630 ◽

2005 ◽

Vol 51 (1) ◽

pp. 125-131 ◽

Cited By ~ 97

Author(s):

Myron Gross ◽

Michael Steffes ◽

David R Jacobs ◽

Xinhua Yu ◽

Linda Lewis ◽

...

Keyword(s):

Coronary Artery ◽

Early Development ◽

Coronary Artery Calcification ◽

Continuous Variable ◽

Oxidation Products ◽

Gas Chromatography Mass Spectrometry ◽

Agatston Score ◽

Reactive Protein ◽

Increased Risk ◽

Coronary Artery Atherosclerosis

Abstract Background: Oxidation of lipids in lipoproteins and cells may initiate and enhance the early development of cardiovascular disease. Method and Results: We assayed F2-isoprostanes, oxidation products of arachidonic acid, by gas chromatography–mass spectrometry in a biracial cohort of 2850 young healthy adult men and women. Coronary artery calcification (CAC), a component of coronary artery atherosclerosis, was detectable in 10% of the cohort and appeared to be in its initial stages (Agatston scores <20 in 47% and <100 in 83% of CAC-positive participants). After adjusting for sex, clinical site, age, and race, the presence of any CAC was 24% more likely among those with high vs low concentrations of F2-isoprostanes [odds ratio (OR) = 1.24 per 92.2 pmol/L (32.7 ng/L; 1 SD of F2-isoprostanes); 95% confidence interval (CI), 1.09–1.41]. The OR was only slightly attenuated [1.18 per 92.2 pmol/L (32.7 ng/L); CI, 1.02–1.38] after further adjustment for body mass index, smoking, serum lipids, C-reactive protein, antioxidant supplementation use, diabetes, and blood pressure. As a continuous variable, the Agatston score increased by 6.9% per 92.2 pmol/L (32.7 ng/L) of F2-isoprostane concentration (P <0.01). Whereas CAC prevalence was lower in women than men, mean (SD), F2-isoprostanes were higher in women {190 (108.9) pmol/L [67.4 (38.6) ng/L]} than in men {140.4 (55.6) pmol/L [49.8 (19.7) ng/L]}. Nevertheless, F2-isoprostanes were associated with an increased risk of CAC in both sexes. Conclusion: This association between increased concentrations of circulating F2-isoprostanes and CAC in young healthy adults supports the hypothesis that oxidative damage is involved in the early development of atherosclerosis.

Download Full-text