ABSTRACT
Introduction: Myocardial injury is associated with COVID-19 mortality, but the prognostic value of adverse right ventricular (RV) remodeling on transthoracic echocardiogram (TTE) is uncertain. Therefore we studied the association between RV dilation and in-hospital mortality in acute COVID19. Methods: We included all adults hospitalized with COVID-19 between March 2020 and February 2021 who had a clinical TTE performed during hospitalization at UCSF Health (Parnassus, Mission Bay, or Mount Zion) or Zuckerberg San Francisco General. Clinical and echo data were extracted from the electronic medical record. Biomarkers (BNP & troponin) were log transformed. The primary exposure was qualitative assessment of RV dilation on TTE and the primary outcome was inhospital mortality. We conducted analysis with STATA MP 16.1 using logistic regression models with adjustment for age and sex (Model 1) and age, sex, log(BNP), log(troponin), and mechanical ventilation (Model 2) and compared models with and without RV size with the likelihood ratio test. Results: There were 225 people hospitalized with COVID-19 who had a clinical TTE performed. The mean age was 62.9 years old, 77 (34%) were female, and 48 (21%) died. The majority of patients identified as Latinx (40%), and most patients received Medicaid (58%). Of 212 TTEs adequate to assess RV size, 47 (22%) had RV dilation of whom 16 (34%) died compared to 31 (19%) with normal RV size (RR 1.81, 95%CI 1.09-3.01, p=0.03). Of 185 TTEs adequate to assess RV function, 18 (10%) had RV dysfunction of whom 6 (33%) died compared to 12 (18%) with normal RV function (RR 1.86, 95%CI 0.89-3.84, p=0.12). There were no differences in tricuspid annulus plane systolic excursion or RV systolic excursion velocity. Adjusted for age and sex, RV dilation was associated with mortality (OR 2.16, 95%CI 1.02-4.58;p=0.045), with a larger effect among those with RV dilation and dysfunction (OR 3.40, 95% CI 0.93-12.4, p=0.063). This effect was attenuated after adjusting for BNP, troponin and mechanical ventilation at the time of TTE (OR 1.61, 95%CI 0.52-4.98, p=0.41). Conclusions: RV dilation on TTE is associated with mortality in acute COVID-19, although the effect is attenuated after accounting for mechanical ventilation and biomarkers.
ABSTRACT
Background. Robust biomarkers that predict disease outcomes amongst COVID19 patients are necessary for both patient triage and resource prioritisation. Numerous candidate biomarkers have been proposed for COVID19. However, at present, there is no consensus on the best diagnostic approach to predict outcomes in infected patients. Moreover, it is not clear whether such tools would apply to other potentially pandemic pathogens and therefore of use as stockpile for future pandemic preparedness. Methods. We conducted a multi cohort observational study to investigate the biology and the prognostic role of interferon alpha inducible protein 27 (IFI27) in COVID19 patients. Findings. We show that IFI27 is expressed in the respiratory tract of COVID19 patients and elevated IFI27 expression is associated with the presence of a high viral load. We further demonstrate that systemic host response, as measured by blood IFI27 expression, is associated with COVID19 severity. For clinical outcome prediction (e.g. respiratory failure), IFI27 expression displays a high positive (0.83) and negative (0.95) predictive value, outperforming all other known predictors of COVID19 severity. Furthermore, IFI27 is upregulated in the blood of infected patients in response to other respiratory viruses. For example, in the pandemic H1N1/09 swine influenza virus infection, IFI27 like genes were highly upregulated in the blood samples of severely infected patients. Interpretation. These data suggest that prognostic biomarkers targeting the family of IFI27 genes could potentially supplement conventional diagnostic tools in future virus pandemics, independent of whether such pandemics are caused by a coronavirus, an influenza virus or another as yet to be discovered respiratory virus.