Increased extravascular lung water index (EVLWI) reflects rapid non-cardiogenic oedema and mortality in COVID-19 associated ARDS

  1. Sebastian Rasch
  2. Paul Schmidle
  3. Sengül Sancak
  4. Alexander Herner
  5. Christina Huberle
  6. Dominik Schulz
  7. Ulrich Mayr
  8. Jochen Schneider
  9. Christoph D. Spinner
  10. Fabian Geisler
  11. Roland M. Schmid
  12. Tobias Lahmer
  13. Wolfgang Huber

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Abstract

Nearly 5% of patients suffering from COVID-19 develop acute respiratory distress syndrome (ARDS). Extravascular lung water index (EVLWI) is a marker of pulmonary oedema which is associated with mortality in ARDS. In this study, we evaluate whether EVLWI is higher in patients with COVID-19 associated ARDS as compared to COVID-19 negative, ventilated patients with ARDS and whether EVLWI has the potential to monitor disease progression. EVLWI and cardiac function were monitored by transpulmonary thermodilution in 25 patients with COVID-19 ARDS subsequent to intubation and compared to a control group of 49 non-COVID-19 ARDS patients. At intubation, EVLWI was noticeably elevated and significantly higher in COVID-19 patients than in the control group (17 (11–38) vs. 11 (6–26) mL/kg; p < 0.001). High pulmonary vascular permeability index values (2.9 (1.0–5.2) versus 1.9 (1.0–5.2); p = 0.003) suggested a non-cardiogenic pulmonary oedema. By contrast, the cardiac parameters SVI, GEF and GEDVI were comparable in both cohorts. High EVLWI values were associated with viral persistence, prolonged intensive care treatment and in-hospital mortality (23.2 ± 6.7% vs. 30.3 ± 6.0%, p = 0.025). Also, EVLWI showed a significant between-subjects (r = − 0.60; p = 0.001) and within-subjects correlation (r = − 0.27; p = 0.028) to Horowitz index. Compared to non COVID-19 ARDS, COVID-19 results in markedly elevated EVLWI-values in patients with ARDS. High EVLWI reflects a non-cardiogenic pulmonary oedema in COVID-19 ARDS and could serve as parameter to monitor ARDS progression on ICU.

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  1. Version published to 10.1038/s41598-021-91043-3
  2. ScreenIT

    SciScore for 10.1101/2020.09.11.20192526: (What is this?)

    Please note, not all rigor criteria are appropriate for all manuscripts.

    Table 1: Rigor

    Institutional Review Board StatementIRB: The study protocol was approved by the Institutional Review Board (Ethics committee of Technical University of Munich; Approval No. 178/20S) as essential part of the register study CORRECT: COVID Registry REChts der Isar intensive care Trial.
    Consent: All patients or their legal representatives gave written informed consent.
    Randomizationnot detected.
    Blindingnot detected.
    Power AnalysisSecondary endpoints: - EVLWI as potential parameter to monitor ARDS progression - SVI, GEF and GEDVI in ARDS patients with and without COVID-19 Power calculation: Based on two independent study groups, a continuous endpoint (EVLWI with a mean of 12.5±4.9mL/kg in the control cohort p-value and an estimated EVLWI of 18±7mL/kg in the COVID-19-cohort, a number of 49 controls and 25 COVID-19-patients would result in a statistical power of >90% with a p-value of p<0.05.20 Statistics: Statistical analysis was performed using IBM SPSS Statistics 25
    Sex as a biological variablenot detected.

    Table 2: Resources

    Software and Algorithms
    SentencesResources
    Secondary endpoints: - EVLWI as potential parameter to monitor ARDS progression - SVI, GEF and GEDVI in ARDS patients with and without COVID-19 Power calculation: Based on two independent study groups, a continuous endpoint (EVLWI with a mean of 12.5±4.9mL/kg in the control cohort p-value and an estimated EVLWI of 18±7mL/kg in the COVID-19-cohort, a number of 49 controls and 25 COVID-19-patients would result in a statistical power of >90% with a p-value of p<0.05.20 Statistics: Statistical analysis was performed using IBM SPSS Statistics 25
    SPSS
    suggested: (SPSS, RRID:SCR_002865)

    Results from OddPub: Thank you for sharing your data.

    Results from LimitationRecognizer: We detected the following sentences addressing limitations in the study:
    Limitations of the study: Due to its design as a mono-center study a selection bias might be discussed. Slight baseline differences of the biometric data from COVID-19 and control cohorts can most likely be explained by older age and predominantly male gender in the COVID-19-cohort.

    Results from TrialIdentifier: We found the following clinical trial numbers in your paper:

    IdentifierStatusTitle
    ISRCTN10077335NANA
    ISRCTN32938630NANA

    Results from Barzooka: We did not find any issues relating to the usage of bar graphs.

    Results from JetFighter: We did not find any issues relating to colormaps.

    Results from rtransparent:
    • Thank you for including a conflict of interest statement. Authors are encouraged to include this statement when submitting to a journal.
    • Thank you for including a funding statement. Authors are encouraged to include this statement when submitting to a journal.
    • No protocol registration statement was detected.

    About SciScore

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  3. Version published to 10.1101/2020.09.11.20192526v1 on medRxiv