Association between Coronary Artery Calcium Burden and Multiple Organ Dysfunction Syndrome in Critically Ill Patients with COVID-19
-
Seyyedeh Marzieh Salami
,
Mohadeseh Zadehmir
,
Nezarali Muolaei
,
Ahmad Ali Davar
,
Saeedeh Sarhadi
,
Amin Mashhadi
Abstract
Background: In this study, we aimed to examine the association between coronary artery calcium (CAC) burden and the severity of multiple organ dysfunction syndrome (MODS) in mechanically ventilated patients with COVID-19.
Methods: We retrospectively evaluated 160 patients with COVID-19 who required invasive mechanical ventilation and were admitted to the intensive care unit. CAC was assessed visually on nongated, noncontrast chest computed tomography (CT) using a semiquantitative Weston scoring system. The extent of organ dysfunction was quantified using the Sequential Organ Failure Assessment (SOFA) score. Associations between CAC burden and SOFA score were examined using the Pearson correlation and one-way analysis of variance, while independent associations were evaluated using multivariable linear regression.
Results: The mean (SD) SOFA score was 5.15 (2.73), and the mean (SD) CAC burden was 4.02 (3.31). In the overall cohort, CAC burden was positively correlated with SOFA score (r=.260; P=.001). This association was more pronounced among patients without pre-existing comorbidities (r=.402; P=.002). However, CAC burden was not independently associated with SOFA score in the multivariable regression model (β=0.009; P=.91). Age (β=0.043; P=.01) and chronic kidney disease (β=2.648; P<.001) were the principal independent correlates of SOFA score after adjustment for clinical covariates.
Conclusion: Although higher CAC burden was associated with higher SOFA scores in unadjusted analyses, this relationship was not independent after multivariable adjustment. CAC assessment on nongated chest CT may provide contextual information regarding underlying vascular disease; however, it should not be interpreted as an isolated marker of organ dysfunction severity, and its incremental clinical value requires confirmation in larger prospective studies.
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23. Vincent JL, Moreno R, Takala J, et al. The SOFA (Sepsis-related Organ Failure Assessment) score to describe organ dysfunction/failure. Intensive Care Med. 1996;22(7):707-10.
24. Zhang Z, Xu X, Ni H, Deng H. Predictive Value of Ionized Calcium in Critically Ill Patients: An Analysis of a Large Clinical Database MIMIC II. PLoS One. 2014;9(4):e95204.
25. Brealey D, Singer M. Multi-organ dysfunction in the critically ill: Effects on different organs. J R Coll Physicians Lond. 2000;34(5):428-31.
26. De Mendonça A, Vincent JL, Suter PM, et al. Acute renal failure in the ICU: Risk factors and outcome evaluated by the SOFA score. Intensive Care Med. 2000;26(7):915-21.
27. Ferreira FL. Serial Evaluation of the SOFA Score to Predict Outcome in Critically Ill Patients. JAMA. 2001;286(14):1754-8.
28. Lee KK, Rahimi O, Lee CK, Shafi A, Hawwass D. A Meta-Analysis: Coronary Artery Calcium Score and COVID-19 Prognosis. Med Sci (Basel). 2022;10(1):5.
29. Zimmermann GS, Fingerle AA, Müller-Leisse C, Gassert F, von Schacky CE, Ibrahim T, et al. Coronary calcium scoring assessed on native screening chest CT imaging as predictor for outcome in COVID-19: An analysis of a hospitalized German cohort. PLoS One. 2020; 15(12):e0244707.
30. Dillinger JG, Benmessaoud FA, Pezel T, Voicu S, Sideris G, Chergui N, et al. Coronary Artery Calcification and Complications in Patients With COVID-19. JACC Cardiovasc Imaging. 2020;13(11):2468-70.
31. Cour M, Bresson D, Hernu R, Argaud L. SOFA score to assess the severity of the post-cardiac arrest syndrome. Resuscitation. 2016;102:110-5.
32. Cereda A, Toselli M, Palmisano A, et al. Coronary calcium score as a predictor of outcomes in the hypertensive Covid-19 population: results from the Italian (S) Core-Covid-19 Registry. Hypertens Res. 2022;45(2):333-43.
33. Kotlo S, Thorgerson A, Kulinski J. Coronary artery calcification as a predictor of adverse outcomes in patients hospitalized with COVID-19. Am Heart J Plus. 2023;28:100288.
2. Msemburi W, Karlinsky A, Knutson V, Aleshin-Guendel S, Chatterji S, Wakefield J. The WHO estimates of excess mortality associated with the COVID-19 pandemic. Nature. 2023;613(7942):130-7.
3. Zhang JJ, Dong X, Cao YY, Yuan YD, Yang YB, Yan YQ, et al. Clinical characteristics of 140 patients infected with SARS-CoV-2 in Wuhan, China. Allergy. 2020 Jul;75(7):1730-41.
4. Cheng LT, Chan LP, Tan BH, Chen RC, Tay KH, Ling ML, et al. Déjà Vu or Jamais Vu? How the Severe Acute Respiratory Syndrome Experience Influenced a Singapore Radiology Department's Response to the Coronavirus Disease (COVID-19) Epidemic. AJR Am J Roentgenol. 2020 Jun;214(6):1206-10.
5. Huang C, Wang Y, Li X, et al. Clinical features of patients infected with 2019 novel coronavirus in Wuhan, China. Lancet. 2020;395(10223):497-506.
6. Arabi YM, Balkhy HH, Hayden FG, et al. Middle East Respiratory Syndrome. N Engl J Med. 2017;376(6):584-94.
7. Bradley BT, Bryan A. Emerging respiratory infections: The infectious disease pathology of SARS, MERS, pandemic influenza, and Legionella. Semin Diagn Pathol. 2019;36(3):152-9.
8. Long B, Brady WJ, Koyfman A, Gottlieb M. Cardiovascular complications in COVID-19. Am J Emerg Med. 2020;38(7):1504-7.
9. Wu Z, McGoogan JM. Characteristics of and Important Lessons from the Coronavirus Disease 2019 (COVID-19) Outbreak in China: Summary of a Report of 72314 Cases from the Chinese Center for Disease Control and Prevention. JAMA - J Am Med Assoc. 2020;323(13):1239-42.
10. Zhou F, Yu T, Du R, Fan G, Liu Y, Liu Z, et al. Clinical Course and Risk Factors for Mortality of Adult Inpatients with COVID-19 in Wuhan. Lancet. 2020;395(10229):1054-62.
11. Ruan Q, Yang K, Wang W, Jiang L, Song J. Clinical predictors of mortality due to COVID-19 based on an analysis of data of 150 patients from Wuhan, China. Intensive Care Med. 2020;46(5):846-8.
12. Keelan PC, Bielak LF, Ashai K, et al. Long-Term Prognostic Value of Coronary Calcification Detected by Electron-Beam Computed Tomography in Patients Undergoing Coronary Angiography. Circulation. 2001;104(4):412-7.
13. Shao L, Yan AT, Lebovic G, Wong HH, Kirpalani A, Deva DP. Prognostic value of visually detected coronary artery calcification on unenhanced non-gated thoracic computed tomography for prediction of non-fatal myocardial infarction and all-cause mortality. J Cardiovasc Comput Tomogr. 2017;11(3):196-202.
14. Shaw LJ, Giambrone AE, Blaha MJ, et al. Long-term prognosis after coronary artery calcification testing in asymptomatic patients: A cohort study. Ann Intern Med. 2015;163(1):14-21.
15. Luo S, Qiu XM, Zeng XJ, et al. Coronary artery calcification and risk of mortality and adverse outcomes in patients with COVID-19: a Chinese multicenter retrospective cohort study. Chinese J Acad Radiol. 2022;5(1):20-8.
16. Martens B, Driessen RGH, Brandts L, et al. Coronary Artery Calcifications Are Associated with More Severe Multiorgan Failure in Patients with Severe Coronavirus Disease 2019 Infection: Longitudinal Results of the Maastricht Intensive Care COVID Cohort. J Thorac Imaging. 2022;37(4):217-24.
17. Chen L, Vavrenyuk A, Ren JH, et al. Prognostic Value of Coronary Artery Calcification Identified by the Semi-quantitative Weston Method in the Emergency Room or Other Hospitalized Patients. Front Cardiovasc Med. 2021;8:684292.
18. Jacobs PCA, Prokop M, Oen AL, Van Der Graaf Y, Grobbee DE, Mali WPTM. Semiquantitative assessment of cardiovascular disease markers in multislice computed tomography of the chest: Interobserver and intraobserver agreements. J Comput Assist Tomogr. 2010;34(2):279-84.
19. Jairam PM, Gondrie MJA, Grobbee DE, Mali WPTM, Jacobs PCA, Van Der Graaf Y. Incidental imaging findings from routine chest CT used to identify subjects at high risk of future cardiovascular events. Radiology. 2014;272(3):700-8.
20. Newby D, Williams M, Hunter A, et al. CT coronary angiography in patients with suspected angina due to coronary heart disease (SCOT-HEART): An open-label, parallel-group, multicentre trial. Lancet. 2015;385(9985):2383-91.
21. Williams MC, Abbas A, Tirr E, Alam S, Nicol E, Shambrook J, et al. Reporting incidental coronary, aortic valve and cardiac calcification on non-gated thoracic computed tomography, a consensus statement from the BSCI/ BSCCT and BSTI. Br J Radiol. 2021; 94(1117):20200894.
22. Kirsch J, Buitrago I, Mohammed TL, Gao T, Asher CR, Novaro GM. Detection of coronary calcium during standard chest computed tomography correlates with multi-detector computed tomography coronary artery calcium score. Int J Cardiovasc Imaging. 2012;28(5):1249-56.
23. Vincent JL, Moreno R, Takala J, et al. The SOFA (Sepsis-related Organ Failure Assessment) score to describe organ dysfunction/failure. Intensive Care Med. 1996;22(7):707-10.
24. Zhang Z, Xu X, Ni H, Deng H. Predictive Value of Ionized Calcium in Critically Ill Patients: An Analysis of a Large Clinical Database MIMIC II. PLoS One. 2014;9(4):e95204.
25. Brealey D, Singer M. Multi-organ dysfunction in the critically ill: Effects on different organs. J R Coll Physicians Lond. 2000;34(5):428-31.
26. De Mendonça A, Vincent JL, Suter PM, et al. Acute renal failure in the ICU: Risk factors and outcome evaluated by the SOFA score. Intensive Care Med. 2000;26(7):915-21.
27. Ferreira FL. Serial Evaluation of the SOFA Score to Predict Outcome in Critically Ill Patients. JAMA. 2001;286(14):1754-8.
28. Lee KK, Rahimi O, Lee CK, Shafi A, Hawwass D. A Meta-Analysis: Coronary Artery Calcium Score and COVID-19 Prognosis. Med Sci (Basel). 2022;10(1):5.
29. Zimmermann GS, Fingerle AA, Müller-Leisse C, Gassert F, von Schacky CE, Ibrahim T, et al. Coronary calcium scoring assessed on native screening chest CT imaging as predictor for outcome in COVID-19: An analysis of a hospitalized German cohort. PLoS One. 2020; 15(12):e0244707.
30. Dillinger JG, Benmessaoud FA, Pezel T, Voicu S, Sideris G, Chergui N, et al. Coronary Artery Calcification and Complications in Patients With COVID-19. JACC Cardiovasc Imaging. 2020;13(11):2468-70.
31. Cour M, Bresson D, Hernu R, Argaud L. SOFA score to assess the severity of the post-cardiac arrest syndrome. Resuscitation. 2016;102:110-5.
32. Cereda A, Toselli M, Palmisano A, et al. Coronary calcium score as a predictor of outcomes in the hypertensive Covid-19 population: results from the Italian (S) Core-Covid-19 Registry. Hypertens Res. 2022;45(2):333-43.
33. Kotlo S, Thorgerson A, Kulinski J. Coronary artery calcification as a predictor of adverse outcomes in patients hospitalized with COVID-19. Am Heart J Plus. 2023;28:100288.
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| COVID-19 Coronary Artery Calcification (CAC) SOFA Score Mechanical Ventilation Chest CT Multiple Organ Dysfunction Syndrome | ||
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How to Cite
1.
Salami SM, Zadehmir M, Muolaei N, Davar AA, Sarhadi S, Mashhadi A. Association between Coronary Artery Calcium Burden and Multiple Organ Dysfunction Syndrome in Critically Ill Patients with COVID-19. Res Heart Yield Transl Med. 2026;.
