Tehran University of Medical Sciences The Research in Heart Yield and Translational Medicine (RHYTHM) 3115-7270 0 0 2026 08 16 2514 2514 Seyyedeh Marzieh Salami Department of Radiology, School of Medicine, Zahedan University of Medical Sciences, Zahedan, Iran Mohadeseh Zadehmir Department of Radiology, School of Medicine, Zahedan University of Medical Sciences, Zahedan, Iran Nezarali Muolaei Pulmonary Diseases, Infectious Diseases and Tropical Medicine Research Center, Research Institute of Cellular and Molecular Sciences in Infectious Diseases, Zahedan University of Medical Sciences, Zahedan, Iran Ahmad Ali Davar Department of Radiology, School of Medicine, Zahedan University of Medical Sciences, Zahedan, Iran Saeedeh Sarhadi Department of Community Medicine, School of Medicine, Health Promotion Research Center, Zahedan University of Medical Sciences, Zahedan, Iran Amin Mashhadi Department of Radiology, School of Medicine, Zahedan University of Medical Sciences, Zahedan, Iran 2026 07 14 2026 08 16 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. https://jthc.tums.ac.ir/index.php/rhythm/article/view/2514 https://jthc.tums.ac.ir/index.php/rhythm/article/download/2514/1296