28-day prognostic value of coronary artery calcification burden in critically ill patients with COVID-19

BACKGROUND: From pathophysiological mechanisms to risk stratification, much debate and discussion persist regarding the coronary artery disease as a risk factor for adverse outcomes in patients with COVID-19. Therefore, the aim of this study was to investigate the role of coronary artery calcification (CAC) burden by non-gated chest computed tomography (CT) for the prediction of 28-day mortality in critically ill patients with COVID-19 admitted to intensive care unit (ICU). METHODS: Consecutive critically ill adult patients with acute respiratory failure due to COVID-19 admitted to ICU who underwent non-contrast non-gated chest CT performed for pneumonia assessment between March and June 2020 (n ​= ​768) were identified. Patients were stratified in four groups: (a) CAC ​= ​0, (b) CAC 1–100, (c) CAC 101–300, and (d) CAC >300. RESULTS: CAC was detected in 376 patients (49%), of whom 218 (58%) showed CAC >300. CAC >300 was independently associated with ICU mortality at 28 days after admission (adjusted hazard ratio [aHR] 1.79, 95% confidence interval [CI] 1.36–2.36, p ​< ​0.001), and incrementally improved prediction of death over a model with clinical features and biomarkers assessed within the first 24h in ICU (likelihood ratio test ​= ​140 vs. 123, respectively, p ​< ​0.001). In the final cohort, 286 (37%) patients died within 28 days of ICU admission. CONCLUSION: In critically ill patients with COVID-19, a high CAC burden quantified with a non-gated chest CT performed for COVID-19 pneumonia assessment is an independent predictor of 28-day mortality, with an incremental prognostic value over a comprehensive clinical assessment during the first 24h in ICU.