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Coronary artery calcification is associated with reduced survival in mechanically ventilated COVID-19 patients in the MaastrICCht cohort
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  • Published: 20 February 2026

Coronary artery calcification is associated with reduced survival in mechanically ventilated COVID-19 patients in the MaastrICCht cohort

  • Esmee Baldussu1,2,
  • Lloyd Brandts3,
  • Francesca Pennetta4,
  • Frank van Rosmalen1,5,
  • Hanke J. Schalkx8,
  • Martijn W. Smulders4,5,7,
  • Iwan C.C. van der Horst1,5,
  • Joachim E. Wildberger4,5,
  • Thijs T.W. van Herpt1,5,
  • Casper Mihl4,5,
  • Bas C.T. van Bussel1,5,6,
  • Bibi Martens4,5 na1 &
  • …
  • Rob G.H. Driessen1,5,7 na1 

Scientific Reports , Article number:  (2026) Cite this article

We are providing an unedited version of this manuscript to give early access to its findings. Before final publication, the manuscript will undergo further editing. Please note there may be errors present which affect the content, and all legal disclaimers apply.

Subjects

  • Cardiovascular diseases
  • Respiratory tract diseases

Abstract

In mechanically ventilated COVID-19 patients, a higher degree of coronary artery calcification (CAC) has been associated with increased severity of multi-organ failure. Furthermore, non-survivors showed worse development of multi-organ failure over time compared to survivors with COVID-19. Nevertheless, it remains unclear whether more CAC is associated with worse long-term survival. Therefore, we studied the association between CAC and one-year survival. In a prospective cohort of 241 mechanically ventilated patients who underwent chest CT scans for clinical evaluation of critical disease, CAC was scored using a semi-quantitative 12-point grading system. Cox proportional hazards analyses were used to investigate the association between CAC score (continuous and tertiles) and one-year survival in crude models and models adjusted for risk factors. In the crude model, a 1-point higher CAC score was associated with a higher hazard ratio (HR) (with 95% confidence interval (CI)) of 1.13 (95%CI: 1.08;1.19, p-value: <0.001). Compared to the lowest tertile (n = 85), a higher mortality was shown for the medium (n = 81) and the highest (n = 75) tertiles, HR 1.21 (95%CI: 0.73;2.02, p-value:0.443) and HR 3.32 (95%CI: 2.10;5.27, p-value:<0.001), respectively. After adjustment for age, sex and APACHE-II score, and comorbidities, a higher CAC score was associated with statistically significant worse one-year survival HR 2.07 (95% CI: 1.18–3.63, p-value:0.012). More coronary artery calcifications (CAC) are associated with worse one-year survival in patients on mechanical ventilation for severe COVID-19.

Data availability

The data that support this study are not publicly available due to their containing information that would compromise the privacy of the research participants. However, the data are available from the corresponding author, E. Baldussu, when requested.

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Author information

Author notes

  1. Bibi Martens and Rob G.H. Driessen contributed equally to this work.

Authors and Affiliations

  1. Department of Intensive Care Medicine, Maastricht University Medical Center+, P. Debyelaan 25, Maastricht, 6229 HX, The Netherlands

    Esmee Baldussu, Frank van Rosmalen, Iwan C.C. van der Horst, Thijs T.W. van Herpt, Bas C.T. van Bussel & Rob G.H. Driessen

  2. Department of Anesthesiology, Maastricht University Medical Center+, P. Debyelaan 25, Maastricht, 6229 HX, The Netherlands

    Esmee Baldussu

  3. Department of Clinical Epidemiology and Medical Technology Assessment, Maastricht University Medical Centre+, P. Debyelaan 25, Maastricht, 6229 HX, The Netherlands

    Lloyd Brandts

  4. Department of Radiology and Nuclear Medicine, Maastricht University Medical Center+, P. Debyelaan 25, Maastricht, 6229 HX, The Netherlands

    Francesca Pennetta, Martijn W. Smulders, Joachim E. Wildberger, Casper Mihl & Bibi Martens

  5. Cardiovascular Research Institute Maastricht (CARIM), Maastricht University, Universiteitssingel 40, Maastricht, 6229 ER, The Netherlands

    Frank van Rosmalen, Martijn W. Smulders, Iwan C.C. van der Horst, Joachim E. Wildberger, Thijs T.W. van Herpt, Casper Mihl, Bas C.T. van Bussel, Bibi Martens & Rob G.H. Driessen

  6. Care and Public Health Research Institute (CAPHRI), Maastricht University, Universiteitssingel 40, Maastricht, 6229 ER, The Netherlands

    Bas C.T. van Bussel

  7. Department of Cardiology, Maastricht University Medical Center+, P. Debyelaan 25, Maastricht, 6229 HX, the Netherlands

    Martijn W. Smulders & Rob G.H. Driessen

  8. Department of Radiology, Radboud University Medical Centre Nijmegen, Geert Grooteplein Zuid 10, 6525 GA, Nijmegen, The Netherlands

    Hanke J. Schalkx

Authors
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Contributions

E.B., L.B and F.P. wrote the main script. F.R. and L.B. collected and analyzed the acquired data. R.D. and B.M. supervised and supported the authors. B.B. and I.H. contributed to the design and inclusion of the original cohort. All authors reviewed the manuscript.

Corresponding author

Correspondence to Esmee Baldussu.

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The authors declare no competing interests.

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Baldussu, E., Brandts, L., Pennetta, F. et al. Coronary artery calcification is associated with reduced survival in mechanically ventilated COVID-19 patients in the MaastrICCht cohort. Sci Rep (2026). https://doi.org/10.1038/s41598-026-40733-x

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  • Received: 20 January 2025

  • Accepted: 16 February 2026

  • Published: 20 February 2026

  • DOI: https://doi.org/10.1038/s41598-026-40733-x

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Keywords

  • Coronary artery calcification
  • Computed tomography, Coronary artery calcium, Mechanical ventilation
  • COVID-19
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