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Early triage echocardiography to predict outcomes in patients admitted with COVID-19: a multicenter study
Daniel Peck1, Andrea Beaton1, Maria Carmo Nunes2,3
1The Heart Institute, Cincinnati Children's Hospital Medical Center, University of Cincinnati School of Medicine, Cincinnati, Ohio, United States.
Insights
In patients with COVID-19, advanced age and low oxygen saturation independently predicted mortality and ICU admission. Echocardiography (echo) findings, including cardiac dysfunction, did not improve outcome prediction in the emergency department (ED).
Area of Science:
- Cardiology
- Infectious Diseases
- Critical Care Medicine
Background:
- Cardiac involvement is a significant factor in COVID-19 prognosis, particularly for critically ill patients.
- Early assessment of cardiac function may aid in predicting outcomes for COVID-19 patients.
Purpose of the Study:
- To evaluate the prognostic value of right ventricular (RV) and left ventricular (LV) dysfunction, assessed by echocardiography (echo), in emergency department (ED) patients with COVID-19.
- To determine if echo variables improve the prediction of hospital mortality and intensive care unit (ICU) admission.
Main Methods:
- A cohort of 399 COVID-19 patients admitted to three US EDs underwent triage echocardiography within 72 hours of symptom onset.
- Clinical data, laboratory results, and COVID-19 symptoms were collected. Logistic regression was used to assess the association between echo variables, demographics, and clinical data with mortality and ICU admission.
Main Results:
- Non-survivors were older, had lower oxygen saturation, and more chronic conditions than survivors.
- Lower left ventricular ejection fraction was observed in non-survivors compared to survivors (50.3±19.7% vs. 58.0±13.6%).
- Advanced age and lower oxygen saturation were independent predictors of death and ICU admission; however, LV and RV function did not independently predict outcomes.
Conclusions:
- In COVID-19 patients presenting to the ED, age and oxygen saturation are independent predictors of mortality and ICU admission.
- Early echocardiography findings, including RV and LV dysfunction, did not enhance the prediction of unfavorable outcomes when added to clinical variables.
Introduction:
Cardiac involvement seems to impact prognosis of COVID-19, especially in critically ill patients. We aimed to assess the prognostic value of right ventricular (RV) and left ventricular (LV) dysfunction, evaluated by bedside triage echocardiography (echo), in patients admitted to emergency departments (ED) in the US with COVID-19. We also assessed the feasibility of using cloud imaging for sharing and interpreting echocardiograms.
Methods:
Patients admitted to three reference EDs with confirmed COVID-19 underwent triage echo within 72 h of symptom onset with remote interpretation. Clinical and laboratory data, as well as COVID-19 symptoms, were collected. The association between echo variables, demographics and clinical data with all-cause hospital mortality and intensive care unit (ICU) admission was assessed using logistic regression.
Results:
Three hundred ninety-nine patients were enrolled, 41% women, with a mean age of 62±16 years. Mean oxygen saturation on presentation was 92.3± 9.2%. Compared to in-hospital survivors, non-survivors were older, had lower oxygen saturation on presentation, were more likely to have a chronic condition and had lower LV ejection fraction (50.3±19.7% vs. 58.0±13.6%) (P < .05). In the cohort, 101 (25%) patients had moderate/severe LV dysfunction, 131 (33%) had moderate/severe RV dysfunction. Advanced age and lower oxygen saturation were independently associated with death and ICU admission. LV and RV function, or other echo variables, were not independent predictors of outcomes.
Conclusion:
In patients admitted with COVID-19 undergoing early echo triage, the independent predictors of death and ICU admission were age and oxygen saturation. The inclusion of echo variables did not improve prediction of unfavorable outcomes.
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