Key result
The presence of coronary artery calcification (Agatston score >0) on initial low-dose chest CT independently predicted admission to ICU, tracheal intubation, or death in COVID-19 patients (OR 33.6).
Why the study?
Cardiovascular comorbidity anticipates severe COVID-19 progression, and the authors investigated whether evaluating coronary calcium burden on initial diagnostic LDCT could predict the need for intensive care treatment.
Does the presence of coronary artery calcification on low-dose chest CT predict severe progression (ICU admission, intubation, or death) in patients with COVID-19?
Cohort (n=89)
Yes
Does the presence of coronary artery calcification on low-dose chest CT predict severe progression (ICU admission, intubation, or death) in patients with COVID-19?
Odds Ratio: 33.6 (95% CI 4.2–456.8)
p-value: p=<0.01
Coronary artery calcification on initial low-dose chest CT is an independent predictor of severe COVID-19 progression, including ICU admission, intubation, or death.
May aid COVID-19 risk stratification on routine CT; hypothesis-generating and should not yet change practice.
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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Fervers et al. (2021) conducted a cohort in COVID-19 (n=89). Coronary artery calcification (Agatston score > 0) vs. No coronary artery calcification (Agatston score = 0) was evaluated on Admission to ICU, tracheal intubation, or death in the 22-day follow-up period (OR 33.6, 95% CI 4.2-456.8, p=<0.01). The presence of coronary artery calcification (Agatston score >0) on initial low-dose chest CT independently predicted admission to ICU, tracheal intubation, or death in COVID-19 patients (OR 33.6).
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