Pulmonary Artery Diameter as a Prognostic Marker for COVID-19 Severity

In patients hospitalized with COVID-19, baseline pulmonary artery diameter (PAD) measurement obtained from non-contrast non-gated computed tomography (NCCT) is a useful prognostic parameter that can facilitate early identification and management of patients at risk for severe disease, according to research findings published in Mayo Clinic Proceedings: Innovations, Quality & Outcomes.

Identification of risk factors predictive of severe COVID-19 is important for determining which patients need early aggressive treatment plans. Researchers therefore evaluated the value of patients’ PAD measurements obtained from NCCT in predicting COVID-19 outcomes.

The investigators conducted a retrospective study between March 2020 and March 2021 at the Hôtel-Dieu de France, a university hospital in Beirut, Lebanon. The study included 464 adult patients (mean age 63.7±16 years; 32.3% women) admitted for severe COVID-19 with a baseline NCCT. Patients under 18 years old or pregnant were excluded. Hospital electronic medical records provided clinical data on participants’ use of invasive mechanical ventilation, intensive care unit (ICU) admission, length of stay, post-COVID-19 functional status (PCFS) scores, patient status, and inhospital mortality.

Patients receiving invasive mechanical ventilation (mean difference 1.1 mm; 95% CI, 0.11-2.04 mm) and patients who were critically ill and admitted to the ICU (mean difference 0.8 mm; 95% CI, 0.40-1.59 mm) had a higher baseline PAD. Researchers found a significant correlation between PAD at baseline and hospital length of stay (r = 0.130; P =.005), discharge status (r =0.117; P =.023), and post-COVID functional scale scores at the 2-month follow-up (r =0.121; P =.021). A PAD of 24.5 mm or more predicted all-cause inhospital death according to multivariable logistic regression independently of cardiovascular disease, C-reactive protein, chronic renal failure, weight, hypertension, and ground glass opacities on CT scan.

Study limitations include nonexclusion of patients with pulmonary hypertension or chronic lung disease, lack of measurements of right ventricular function and pulmonary arterial pressure, and lack of data on PAD prior to baseline. Additionally, patients studied were largely White and from a single facility.

Study findings suggest that in patients with COVID-19 infection, measurement of baseline PAD using NCCT upon hospitalization “is an independent risk factor for inhospital mortality that can help identify severe cases and be a useful prognostic parameter,” the researchers concluded.  

Reference

Ismail A, Riachy M, Awali M, et al. Pulmonary artery enlargement: an independent risk factor for mortality in hospitalized COVID-19 patients. Mayo Clin Proc Innov Qual Outcomes. Published online July 21, 2022. doi:10.1016/j.mayocpiqo.2022.07.001