AUTHOR=Gao Weibo , Fan Jiasai , Sun Di , Yang Mengxi , Guo Wei , Tao Liyuan , Zheng Jingang , Zhu Jihong , Wang Tianbing , Ren Jingyi 

TITLE=Heart Failure Probability and Early Outcomes of Critically Ill Patients With COVID-19: A Prospective, Multicenter Study

JOURNAL=Frontiers in Cardiovascular Medicine

VOLUME=Volume 8 - 2021

YEAR=2021

URL=https://www.frontiersin.org/journals/cardiovascular-medicine/articles/10.3389/fcvm.2021.738814

DOI=10.3389/fcvm.2021.738814

ISSN=2297-055X

ABSTRACT=Background: Relationship between cardiac functions with fatal outcome of 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 multi-center and prospective study, a total of 1050 patients with clinical suspicion of COVID-19 were consecutively screened and 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 the mortality.

Results: Within 30 days follow-up, 27.4% of the 402 patients died. The mortality rate of patients with HF likely was significantly higher than those with grey zone and HF unlikely (40.8% vs. 25% and 16.5% respectively, P < 0.001). HF likely (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 1.00~1.04) were independently associated with the prognosis of critically ill patients with COVID-19. Moreover, a nomogram was developed with bootstrap validation and the C-index was 0.80 (95% CI 0.74~0.86).

Conclusions: The present 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 ‘triple cut-point’ strategy of NT-proBNP, which could assist risk stratification and improve clinical sequelae.