Predictors of in-hospital mortality in critically ill patients with COVID-19: A large dual tertiary centre study

Chiara Cirillo, Eleni Nakou, Georgios Georgiopoulos, Christos Tountas, Kelly Victor, Apostolia Marvaki, Nishita Desai, Richard Fisher, Matthew Ryan, Ozan M. Demir, Eleanor Corcoran, Kevin O'Gallagher, Hannah Sinclair, Ana Pericao, Anender Dhariwal, Vasileios Stylianidis, Alina Hua, Adam Abner Nabeebaccus, Peter Pearson, Tiago FonsecaAndrew Osborne, Eva Toth, Mark Zuckerman, Ajay M. Shah, Divaka Perera, Mark Monaghan, Gerald Carr-White, Alexandros Papachristidis*

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review

1 Citation (Scopus)


Objectives The aim of this study was to investigate the relationship of echocardiographic parameters, laboratory findings and clinical characteristics with in-hospital mortality in adult patients with COVID-19 admitted to the intensive care units (ICU) in two large collaborating tertiary UK centres. Design Observational retrospective study. Setting The study was conducted in patients admitted to the ICU in two large tertiary centres in London, UK. Participants Inclusion criteria were: (1) patients admitted to the ICU with a COVID-19 diagnosis over a period of 16 weeks. and (2) underwent a transthoracic echocardiogram on the first day of ICU admission as clinically indicated. No exclusion criteria applied. Three hundred patients were enrolled and completed the follow-up. Primary and secondary outcome measures The outcome measure in this study was in-hospital mortality in patients admitted to the ICU with COVID-19 infection. Results Older age (HR: 1.027, 95% CI 1.007 to 1.047; p=0.008), left ventricular (LV) ejection fraction<35% (HR: 5.908, 95% CI 2.609 to 13.376; p<0.001), and peak C reactive protein (CRP) (HR: 1.002, 95% CI 1.001 to 1.004, p=0.001) were independently correlated with mortality in a multivariable Cox regression model. Following multiple imputation of variables with more than 5% missing values, random forest analysis was applied to the imputed data. Right ventricular (RV) basal diameter (RVD1), RV mid-cavity diameter (RVD2), tricuspid annular plane systolic excursion, RV systolic pressure, hypertension, RV dysfunction, troponin level on admission, peak CRP, creatinine level on ICU admission, body mass index and age were found to have a high relative importance (> 0.7). Conclusions In patients with COVID-19 in the ICU, both severely impaired LV function and impaired RV function may have adverse prognostic implications, but older age and inflammatory markers appear to have a greater impact. A combination of echocardiographic and laboratory investigations as well as demographic and clinical characteristics appears appropriate for risk stratification in patients with COVID-19 who are admitted to the ICU.

Original languageEnglish
Article numbere059358
JournalBMJ Open
Issue number12
Early online date1 Dec 2022
Publication statusPublished - Dec 2022


  • Adult cardiology
  • COVID-19
  • Echocardiography


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