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

Abstract

Purpose 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. Material and methods 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. Results 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. Conclusions 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.

Computed tomography measured epicardial adipose tissue and psoas muscle attenuation: new biomarkers to predict major adverse cardiac events (MACE) and mortality in patients with heart disease and critically ill patients. Part I: Epicardial adipose tissue

“…Millman et al . investigated the contribution of cardiac and lung ultrasound and clinical variables by developing a straightforward point-of-care POCOVID score system to predict short-term mortality in critical COVID-19 patients [ 147 ]. They showed that deceased patients were generally older, had worse values for SOFA score, increased baseline troponin levels, reduced left ventricular ejection fraction (LVEF), impaired LV diastolic function, and increased EATth, despite a similar prevalence of severe lung ultrasound scores.…”

“…The POCOVID score, including age (> 60 years), myocardial injury (LVEF < 50% or TnI > 99 th percentile), and increased EATth (> 0.8 cm), was created. The presence of two out of these three criteria identified patients with almost twice the risk of death [ 147 ].…”