The following is a summary of “Prognostic role of cardiac and inflammatory biomarkers in extubation failure in patients with COVID-19 acute respiratory distress syndrome,” published in the January 2025 issue of Critical Care by Groenland et al. 

An extubation failure was linked to higher morbidity, highlighting the need to explore factors and optimize extubation practices, with biomarkers playing a limited predictive role.  

Researchers conducted a retrospective study to analyze the prognostic value of cardiac biomarkers (N-terminal pro–B-type natriuretic peptide (NT-proBNP), High-sensitivity Troponin T (Hs-TnT)) and inflammatory biomarkers (Interleukin-6 (IL-6), Procalcitonin (PCT)) for extubation failure in patients with COVID-19 acute respiratory distress syndrome (C-ARDS). 

They extracted patient characteristics and laboratory data from electronic medical records. Eligible patients were those extubated after mechanical ventilation. The primary endpoint was extubation failure, defined as reintubation or death within 7 days post-extubation, regardless of post-extubation respiratory support. Uni- and multivariable logistic regression were used to examine the association between biomarkers and extubation failure, with biomarkers log₂  transformed.  

The results showed that 21.5% of the 297 patients experienced extubation failure. In univariable analysis, NT-proBNP (OR 1.24, 95% CI 1.06–1.47), Hs-TnT (OR 1.72, 95% CI 1.37–2.19), and PCT (OR 1.38, 95% CI 1.16–1.65) on the day of extubation were significantly associated with extubation failure. After adjusting for clinical variables (age, duration of mechanical ventilation, SOFA score), Hs-TnT remained the only biomarker independently associated with extubation failure (adjusted OR 1.38, 95% CI 1.02–1.90). Patients with elevated Hs-TnT (≥ 14 ng/mL) and PCT (≥ 0.25 ng/mL) had the highest extubation failure risk (46%), while those with normal levels had only a 13% risk.  

Investigators concluded that while multiple biomarkers (Hs-TnT, NT-proBNP, PCT) were associated with extubation failure in mechanically ventilated patients with C-ARDS, only Hs-TnT demonstrated an independent association, suggesting its potential as an objective tool for assessing extubation readiness. 

Source: annalsofintensivecare.springeropen.com/articles/10.1186/s13613-025-01425-3