The prognostic role of cardiac and inflammatory biomarkers in extubation failure in patients with COVID-19 acute respiratory distress syndrome.

Summary

Among 297 extubated C-ARDS patients, 21.5% failed extubation. On the day of extubation, Hs‑TnT, NT‑proBNP, and PCT were associated with failure in univariable analyses; only Hs‑TnT remained independently associated after adjusting for age, ventilation days, and SOFA (adjusted OR 1.38, 95% CI 1.02–1.90). Combined elevation of Hs‑TnT and PCT identified a 46% failure risk vs 13% when both were normal.

Key Findings

• Extubation failure occurred in 21.5% of 297 C‑ARDS patients.
• On extubation day, Hs‑TnT (OR 1.72), NT‑proBNP (OR 1.24), and PCT (OR 1.38) were associated with failure in univariable analyses.
• After multivariable adjustment, only Hs‑TnT remained independently associated (adjusted OR 1.38, 95% CI 1.02–1.90). Combined elevated Hs‑TnT (≥14 ng/mL) and PCT (≥0.25 ng/mL) conferred a 46% failure risk vs 13% when both normal.

Clinical Implications

Consider incorporating Hs‑TnT into extubation readiness assessments in C‑ARDS, alongside clinical variables; patients with elevated Hs‑TnT (± elevated PCT) may benefit from enhanced monitoring, optimization, or delayed extubation.

Limitations

• Single-center retrospective design limits generalizability and causal inference.
• Focused on C‑ARDS; applicability to non-COVID ARDS requires validation.

Future Directions

Prospective multicenter validation and integration of Hs‑TnT with clinical indices and physiologic weaning tests to build multivariable risk models; assessment of biomarker-guided extubation strategies.