Rapid prognostic stratification using Point of Care ultrasound in critically ill COVID patients: The role of epicardial fat thickness, myocardial injury and age

• Published in: Journal of critical care Vol. 67; pp. 33 - 38
• Main Authors: Millman, Michael, Santos, Angela B.S., Pianca, Eduardo G., Pellegrini, José Augusto Santos, Conci, Fernanda Carine, Foppa, Murilo
• Format: Journal Article
• Language: English
• Published: United States Elsevier Inc 01.02.2022; Elsevier Limited
• Subjects: Biomarkers; Body fat; Coronaviruses; COVID-19; Critical care; Critical Illness; Disease transmission; Ejection fraction; Epicardial Fat; Epidemics; Female; Hospitalization; Hospitals; Humans; Hypertension; Intensive care; Male; Medical prognosis; Middle Aged; Mortality; Obesity; Pandemics; Patients; Point-of-Care Systems; Prognosis; Pulmonary arteries; SARS-CoV-2; Severe acute respiratory syndrome coronavirus 2; Stroke Volume; Ultrasonic imaging; Ultrasound; Variables; Ventricular Function, Left; COVID-19; Critical care; Prognosis; Ultrasound; Epicardial Fat
• ISSN: 0883-9441; 1557-8615
• DOI: 10.1016/j.jcrc.2021.09.013

The burden of critical COVID-19 patients in intensive care units (ICU) demands new tools to stratify patient risk. We aimed to investigate the role of cardiac and lung ultrasound, together with clinical variables, to propose a simple score to help predict short-term mortality in these patients. We collected clinical and laboratorial data, and a point-of-care cardiac and lung ultrasound was performed in the first 36 h of admission in the ICU. Out of 78 patients (61 ± 12y-o, 55% male), 33 (42%) died during the hospitalization. Deceased patients were generally older, had worse values for SOFA score, baseline troponin levels, left ventricular ejection fraction (LVEF), LV diastolic function, and increased epicardial fat thickness (EFT), despite a similar prevalence of severe lung ultrasound scores. Based on the multivariable model, we created the POCOVID score, including age (>60 years), myocardial injury (LVEF<50% and/or usTnI>99til), and increased EFT (>0.8 cm). The presence of two out of these three criteria identified patients with almost twice the risk of death. A higher POCOVID score at ICU admission can be helpful to stratify critical COVID-19 patients with increased in-hospital mortality and to optimize medical resources allocation in more strict-resource settings. •Out of 78 patients from a reference ICU center for critical COVID‐19, 33 (42%) died during the hospitalization.•Using point-of-care ultrasound, age, myocardial injury and epicardial fat thickness, predicted mortality.•POCOVID score includes >60years-old, myocardial injury (EF<50% and/or usTnI>99til), and epicardial fat thickness (>0.8cm).•POCOVID score with 2 out 3 criteria indicates twice the risk of death of critical COVID-19 patients at ICU admission.