tetano
Editor, Senior Moderator
Front Cardiovasc Med
. 2021 Nov 26;8:738814.
doi: 10.3389/fcvm.2021.738814. eCollection 2021.
Heart Failure Probability and Early Outcomes of Critically Ill Patients With COVID-19: A Prospective, Multicenter Study
Weibo Gao[SUP] 1 [/SUP], Jiasai Fan[SUP] 2 [/SUP], Di Sun[SUP] 2 [/SUP], Mengxi Yang[SUP] 2 [/SUP], Wei Guo[SUP] 3 [/SUP], Liyuan Tao[SUP] 4 [/SUP], Jingang Zheng[SUP] 2 [/SUP], Jihong Zhu[SUP] 1 [/SUP], Tianbing Wang[SUP] 3 [/SUP], Jingyi Ren[SUP] 2 [/SUP]
Affiliations
Abstract
Background: The relationship between cardiac functions and the fatal outcome of coronavirus disease 2019 (COVID-19) is still largely underestimated. We aim to explore the role of heart failure (HF) and NT-proBNP in the prognosis of critically ill patients with COVID-19 and construct an easy-to-use predictive model using machine learning. Methods: In this multicenter and prospective study, a total of 1,050 patients with clinical suspicion of COVID-19 were consecutively screened. Finally, 402 laboratory-confirmed critically ill patients with COVID-19 were enrolled. A "triple cut-point" strategy of NT-proBNP was applied to assess the probability of HF. The primary outcome was 30-day all-cause in-hospital death. Prognostic risk factors were analyzed using the least absolute shrinkage and selection operator (LASSO) and multivariate logistic regression, further formulating a nomogram to predict mortality. Results: Within a 30-day follow-up, 27.4% of the 402 patients died. The mortality rate of patients with HF likely was significantly higher than that of the patient with gray zone and HF unlikely (40.8% vs. 25 and 16.5%, respectively, P < 0.001). HF likely [Odds ratio (OR) 1.97, 95% CI 1.13-3.42], age (OR 1.04, 95% CI 1.02-1.06), lymphocyte (OR 0.36, 95% CI 0.19-0.68), albumin (OR 0.92, 95% CI 0.87-0.96), and total bilirubin (OR 1.02, 95% CI 1-1.04) were independently associated with the prognosis of critically ill patients with COVID-19. Moreover, a nomogram was developed by bootstrap validation, and C-index was 0.8 (95% CI 0.74-0.86). Conclusions: This study established a novel nomogram to predict the 30-day all-cause mortality of critically ill patients with COVID-19, highlighting the predominant role of the "triple cut-point" strategy of NT-proBNP, which could assist in risk stratification and improve clinical sequelae.
Keywords: COVID-19; NT-ProBNP; heart failure; nomogram; prognosis.
. 2021 Nov 26;8:738814.
doi: 10.3389/fcvm.2021.738814. eCollection 2021.
Heart Failure Probability and Early Outcomes of Critically Ill Patients With COVID-19: A Prospective, Multicenter Study
Weibo Gao[SUP] 1 [/SUP], Jiasai Fan[SUP] 2 [/SUP], Di Sun[SUP] 2 [/SUP], Mengxi Yang[SUP] 2 [/SUP], Wei Guo[SUP] 3 [/SUP], Liyuan Tao[SUP] 4 [/SUP], Jingang Zheng[SUP] 2 [/SUP], Jihong Zhu[SUP] 1 [/SUP], Tianbing Wang[SUP] 3 [/SUP], Jingyi Ren[SUP] 2 [/SUP]
Affiliations
- PMID: 34901205
- PMCID: PMC8660969
- DOI: 10.3389/fcvm.2021.738814
Abstract
Background: The relationship between cardiac functions and the fatal outcome of coronavirus disease 2019 (COVID-19) is still largely underestimated. We aim to explore the role of heart failure (HF) and NT-proBNP in the prognosis of critically ill patients with COVID-19 and construct an easy-to-use predictive model using machine learning. Methods: In this multicenter and prospective study, a total of 1,050 patients with clinical suspicion of COVID-19 were consecutively screened. Finally, 402 laboratory-confirmed critically ill patients with COVID-19 were enrolled. A "triple cut-point" strategy of NT-proBNP was applied to assess the probability of HF. The primary outcome was 30-day all-cause in-hospital death. Prognostic risk factors were analyzed using the least absolute shrinkage and selection operator (LASSO) and multivariate logistic regression, further formulating a nomogram to predict mortality. Results: Within a 30-day follow-up, 27.4% of the 402 patients died. The mortality rate of patients with HF likely was significantly higher than that of the patient with gray zone and HF unlikely (40.8% vs. 25 and 16.5%, respectively, P < 0.001). HF likely [Odds ratio (OR) 1.97, 95% CI 1.13-3.42], age (OR 1.04, 95% CI 1.02-1.06), lymphocyte (OR 0.36, 95% CI 0.19-0.68), albumin (OR 0.92, 95% CI 0.87-0.96), and total bilirubin (OR 1.02, 95% CI 1-1.04) were independently associated with the prognosis of critically ill patients with COVID-19. Moreover, a nomogram was developed by bootstrap validation, and C-index was 0.8 (95% CI 0.74-0.86). Conclusions: This study established a novel nomogram to predict the 30-day all-cause mortality of critically ill patients with COVID-19, highlighting the predominant role of the "triple cut-point" strategy of NT-proBNP, which could assist in risk stratification and improve clinical sequelae.
Keywords: COVID-19; NT-ProBNP; heart failure; nomogram; prognosis.