Abstract
(1) Background: Respiratory insufficiency with acute respiratory distress syndrome (ARDS) and multi-organ dysfunction leads to high mortality in COVID-19 patients. In times of limited intensive care unit (ICU) resources, chest CTs became an important tool for the assessment of lung involvement and for patient triage despite uncertainties about the predictive diagnostic value. This study evaluated chest CT-based imaging parameters for their potential to predict in-hospital mortality compared to clinical scores. (2) Methods: 89 COVID-19 ICU ARDS patients requiring mechanical ventilation or continuous positive airway pressure mask ventilation were included in this single center retrospective study. AI-based lung injury assessment and measurements indicating pulmonary hypertension (PA-to-AA ratio) on admission CT, oxygenation indices, lung compliance and sequential organ failure assessment (SOFA) scores on ICU admission were assessed for their diagnostic performance to predict in-hospital mortality. (3) Results: CT severity scores and PA-to-AA ratios were not significantly associated with in-hospital mortality, whereas the SOFA score showed a significant association (p < 0.001). In ROC analysis, the SOFA score resulted in an area under the curve (AUC) for in-hospital mortality of 0.74 (95%-CI 0.63–0.85), whereas CT severity scores (0.53, 95%-CI 0.40–0.67) and PA-to-AA ratios (0.46, 95%-CI 0.34–0.58) did not yield sufficient AUCs. These results were consistent for the subgroup of more critically ill patients with moderate and severe ARDS on admission (oxygenation index <200, n = 53) with an AUC for SOFA score of 0.77 (95%-CI 0.64–0.89), compared to 0.55 (95%-CI 0.39–0.72) for CT severity scores and 0.51 (95%-CI 0.35–0.67) for PA-to-AA ratios. (4) Conclusions: Severe COVID-19 disease is not limited to lung (vessel) injury but leads to a multi-organ involvement. The findings of this study suggest that risk stratification should not solely be based on chest CT parameters but needs to include multi-organ failure assessment for COVID-19 ICU ARDS patients for optimized future patient management and resource allocation.
Highlights
In the ongoing coronavirus disease 2019 (COVID-19) pandemic, the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) has globally caused an enormous socioeconomic burden and large numbers of deaths [1]
The findings of this study suggest that risk stratification should not solely be based on chest CT parameters but needs to include multi-organ failure assessment for COVID-19 intensive care unit (ICU) acute respiratory distress syndrome (ARDS) patients for optimized future patient management and resource allocation
The aim of the study was to analyze the discriminative value of quantitative CT imaging biomarkers as well as of the sequential organ failure assessment (SOFA) score upon ICU admission of severely ill SARS-CoV-2 PCR-positive ICU patients (n = 89) who developed ARDS in need of invasive-ventilation therapy or CPAP-mask ventilation for mortality prediction
Summary
In the ongoing coronavirus disease 2019 (COVID-19) pandemic, the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) has globally caused an enormous socioeconomic burden and large numbers of deaths [1]. Around 15–30% of COVID-19 inpatients require intensive care treatment and invasive ventilation, and a substantial subpopulation of around three quarters of intensive care unit (ICU) patients develop respiratory failure such as acute respiratory distress syndrome (ARDS) [8,9,10,11,12,13,14]. Pulmonary involvement in COVID-19 disease with the development of respiratory insufficiency and ARDS is considered as one of the major complications and drivers for disease progression to critical stages and for fatalities [15,16]. Apart from ARDS, disease prognosis has largely been influenced by multi-organ involvement such as heart failure, kidney failure and liver damage [26,27]
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