AUTHOR=Beyls Christophe , Martin Nicolas , Booz Thomas , Viart Christophe , Boisgard Solenne , Daumin Camille , Crombet Maxime , Epailly Julien , Huette Pierre , Dupont Hervé , Abou-Arab Osama , Mahjoub Yazine 

TITLE=Prognostic value of acute cor pulmonale in COVID-19-related pneumonia: A prospective study

JOURNAL=Frontiers in Medicine

VOLUME=9

YEAR=2022

URL=https://www.frontiersin.org/journals/medicine/articles/10.3389/fmed.2022.824994

DOI=10.3389/fmed.2022.824994

ISSN=2296-858X

ABSTRACT=<sec><title>Background</title><p>It is known that acute cor pulmonale (ACP) worsens the prognosis of non-coronavirus disease 2019 (COVID-19) acute respiratory distress syndrome (NC-ARDS). The ACP risk score evaluates the risk of ACP occurrence in mechanically ventilated patients with NC-ARDS. There is less data on the risk factors and prognosis of ACP induced by COVID-19-related pneumonia.</p></sec><sec><title>Objective</title><p>The objective of this study was to evaluate the prognostic value of ACP, assessed by transthoracic echocardiography (TTE) and clinical factors associated with ACP in a cohort of patients with COVID-19-related pneumonia.</p></sec><sec><title>Materials and methods</title><p>Between February 2020 and June 2021, patients admitted to intensive care unit (ICU) at Amiens University Hospital for COVID-19-related pneumonia were assessed by TTE within 48 h of admission. ACP was defined as a right ventricle/left ventricle area ratio of &gt;0.6 associated with septal dyskinesia. The primary outcome was mortality at 30 days.</p></sec><sec><title>Results</title><p>Among 146 patients included, 36% (<italic>n</italic> = 52/156) developed ACP of which 38% (<italic>n</italic> = 20/52) were non-intubated patients. The classical risk factors of ACP (found in NC-ARDS) such as PaCO<sub>2</sub> &gt;48 mmHg, driving pressure &gt;18 mmHg, and PaO<sub>2</sub>/FiO<sub>2</sub> &lt; 150 mmHg were not associated with ACP (all <italic>P</italic>-values &gt; 0.1). The primary outcome occurred in 32 (22%) patients. More patients died in the ACP group (<italic>n</italic> = 20/52 (38%) vs. <italic>n</italic> = 12/94 (13%), <italic>P</italic> = 0.001). ACP [hazards ratio (HR) = 3.35, 95%CI [1.56–7.18], <italic>P</italic> = 0.002] and age &gt;65 years (HR = 2.92, 95%CI [1.50–5.66], <italic>P</italic> = 0.002) were independent risk factors of 30-day mortality.</p></sec><sec><title>Conclusion</title><p>ACP was a frequent complication in ICU patients admitted for COVID-19-related pneumonia. The 30-day-mortality was 38% in these patients. In COVID-19-related pneumonia, the classical risk factors of ACP did not seem relevant. These results need confirmation in further studies.</p></sec>