Aaron Byczynski, DO; Muhammad Hammad, MD; Julia Wilson, MD; Yilin Xu, MS; Jacquelyn Kulinski, MD
WMJ. 2026;125(4):482-488. Published November 1, 2026.
ABSTRACT
Introduction: Coronary artery calcification (CAC), identified on routine chest computed tomography (CT), has been associated with worse outcomes in hospitalized patients with COVID-19. The COVID-GRAM Score is a risk stratification tool developed to predict critical illness in this population. This study compared the predictive performance of CAC identified on chest CT with that of the COVID-GRAM Score for intensive care unit (ICU) admission among hospitalized patients with COVID-19 and evaluated whether combining these measures improved identification of high-risk patients. We hypothesized that CAC would outperform the COVID-GRAM Score.
Methods: This retrospective cohort study includes 238 adults hospitalized with COVID-19 at a large academic medical center in Milwaukee, Wisconsin, between July 1, 2020, and July 1, 2021. Data were obtained through electronic medical record database queries and chart review. Eligible patients had confirmed COVID-19 infection and no prior history of coronary artery disease.
Results: Statistical analyses included descriptive statistics, sensitivity and specificity analyses, and receiver operating characteristic (ROC) curve analysis. The mean age was 64 [SD, 15] years, and 46.2% of patients were women. Patients admitted to the ICU had higher mean COVID-GRAM Scores than those not admitted to the ICU (mean [SD], 168 [45.4] vs 150 [44); P = .01). Any CAC was present in 54.2% of ICU-admitted patients compared with 39.1% of patients not admitted to the ICU, and severe CAC was more common among ICU-admitted patients (18.6% vs 5.6%). The area under the ROC curve (AUC) was 0.61 for illness risk score derived from the COVID-GRAM model, compared with 0.58 for any CAC and 0.57 for severe CAC. Composite measures combining CAC and illness risk score did not improve discriminatory performance.
Conclusions: Neither the COVID-GRAM Score nor CAC effectively predicted ICU admission among hospitalized patients with COVID-19. Combining CAC with the illness risk score did not significantly improve predictive performance, highlighting the need for more robust risk stratification tools.