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

Sebastian Rasch, Paul Schmidle, Sengül Sancak, Alexander Herner, Christina Huberle, Dominik Schulz, Ulrich Mayr, Jochen Schneider, Christoph D Spinner, Fabian Geisler, Roland M Schmid, Tobias Lahmer, Wolfgang Huber, Sebastian Rasch, Paul Schmidle, Sengül Sancak, Alexander Herner, Christina Huberle, Dominik Schulz, Ulrich Mayr, Jochen Schneider, Christoph D Spinner, Fabian Geisler, Roland M Schmid, Tobias Lahmer, Wolfgang Huber

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.

Conflict of interest statement

Tobias Lahmer received travel grants from Gilead, Pfizer and MSD. Sebastian Rasch received travel grants from Gilead. Christoph Spinner collaborates with AbbVie, Gilead, Janssen-Cilag, MSD and ViiV Healthcare/GSK as member of the advisory board and received travel and study grants. Wolfgang Huber collaborated with Pulsion Medical Systems SE, Feldkirchen, Germany as member of the Medical Advisory Board. All other authors declare no conflict of interest.

Figures

Figure 1
Figure 1
Boxplots comparing extra vascular lung water index (EVLWI) and pulmonary vascular permeability index (PVPI) on day 1 and highest EVLWI between patients with and without COVID-19; * indicates significance with p 

Figure 2

Extra vascular lung water index…

Figure 2

Extra vascular lung water index (EVLWI) of patients with COVID-19 who required less…

Figure 2
Extra vascular lung water index (EVLWI) of patients with COVID-19 who required less and more than 14 days of treatment on intensive care unit (ICU).
Figure 2
Figure 2
Extra vascular lung water index (EVLWI) of patients with COVID-19 who required less and more than 14 days of treatment on intensive care unit (ICU).

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