Abstract
PurposeCardiovascular 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.MethodsEighty-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).ResultsAfter 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]).ConclusionCAC scoring on LDCT might help to predict future obligation of intensive care treatment at the day of patient admission to the hospital.
Highlights
Coronavirus Disease 2019 (COVID-19) most commonly manifests by unspecific and mild symptoms [1]
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])
Severe complications include respiratory failure, sepsis and acute cardiac injury, which regularly imply obligation of intensive care treatment and invasive ventilation [2,3,4,5]. Such severe progression of COVID-19 is promoted by preexisting comorbidity and, above all, cardiovascular risk factors (CRF) [2, 3, 5,6,7,8]
Summary
Coronavirus Disease 2019 (COVID-19) most commonly manifests by unspecific and mild symptoms [1]. Severe complications include respiratory failure, sepsis and acute cardiac injury, which regularly imply obligation of intensive care treatment and invasive ventilation [2,3,4,5] Such severe progression of COVID-19 is promoted by preexisting comorbidity and, above all, cardiovascular risk factors (CRF) [2, 3, 5,6,7,8]. Acknowledged risk factors for development of atherosclerotic calcification include high age, active smoking, diabetes mellitus, dyslipidemia and arterial hypertension [12]. These promoters of atherosclerosis are known to entail a poor prognosis in COVID-19, as explained above
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