{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,21]],"date-time":"2026-08-21T21:44:40Z","timestamp":1787348680386,"version":"build-2736575974"},"reference-count":27,"publisher":"MDPI AG","issue":"22","license":[{"start":{"date-parts":[[2025,11,18]],"date-time":"2025-11-18T00:00:00Z","timestamp":1763424000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"name":"Victor Babes University of Medicine and Pharmacy, Timisoara, Romania"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JCM"],"abstract":"<jats:p>Background\/Objectives: Acute pulmonary edema (APE) has emerged as an overlooked but life-threatening manifestation of COVID-19, reflecting the intersection of inflammatory, endothelial, and cardiac injury pathways. This study aimed to determine the incidence, independent predictors, and long-term pulmonary sequelae of APE in hospitalized COVID-19 patients. Materials and Methods: We conducted a retrospective cohort study including 127 consecutively admitted adults with confirmed SARS-CoV-2 infection at a tertiary-care center in Romania. Demographic, clinical, biochemical, and imaging data were analyzed. Multivariate logistic regression identified independent predictors of APE and in-hospital mortality, while three-month follow-up assessed pulmonary recovery and biomarker dynamics. Results: APE occurred in 36.2% of patients and was associated with a four-fold increase in in-hospital mortality (43.5% vs. 12.3%, p &lt; 0.001). Elevated NT-proBNP, troponin I, and IL-6 levels independently predicted both APE occurrence and mortality. APE patients required more frequent ICU admission (52.2% vs. 18.5%, p &lt; 0.001) and had longer hospital stays. At three months, 39% of APE survivors exhibited fibrotic CT changes, and 37% had restrictive ventilatory defects, correlating with persistently increased NT-proBNP and IL-6 concentrations. Conclusions: Acute pulmonary edema delineates a distinct cardio-inflammatory phenotype of COVID-19, driven by endothelial dysfunction and biomarker-elevated cardiac stress. Early biomarker-guided fluid management and structured multidisciplinary follow-up may mitigate both acute mortality and chronic pulmonary sequelae in post-COVID populations.<\/jats:p>","DOI":"10.3390\/jcm14228188","type":"journal-article","created":{"date-parts":[[2025,11,19]],"date-time":"2025-11-19T12:55:31Z","timestamp":1763556931000},"page":"8188","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":3,"title":["Acute Pulmonary Edema in COVID-19: Clinical Predictors, Long-Term Pulmonary Sequelae, and Mortality in a Romanian Cohort Study"],"prefix":"10.3390","volume":"14","author":[{"ORCID":"https:\/\/orcid.org\/0009-0009-4951-1702","authenticated-orcid":false,"given":"Diana-Maria","family":"Mateescu","sequence":"first","affiliation":[{"name":"Doctoral School, Department of General Medicine, \u201cVictor Babes\u201d University of Medicine and Pharmacy, Eftimie Murgu Square 2, 300041 Timisoara, Romania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Dragos-Mihai","family":"Gavrilescu","sequence":"additional","affiliation":[{"name":"Department of Orthodontics, Dental District, Strada Z\u0103gazului Nr. 3, ONE Floreasca Vista, Sector 1, 014261 Bucharest, Romania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Andrei","family":"Marginean","sequence":"additional","affiliation":[{"name":"Department of Surgery, \u201cDr. Victor Popescu\u201d Emergency Military Hospital, 9 Gheorghe Laz\u0103r Street, 300080 Timi\u0219oara, Romania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ioana-Georgiana","family":"Cotet","sequence":"additional","affiliation":[{"name":"Doctoral School, Department of General Medicine, \u201cVictor Babes\u201d University of Medicine and Pharmacy, Eftimie Murgu Square 2, 300041 Timisoara, Romania"},{"name":"Centre of Molecular Research in Nephrology and Vascular Disease, \u201cVictor Babes\u201d University of Medicine and Pharmacy, 300041 Timisoara, Romania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Elena-Cristina","family":"Guse","sequence":"additional","affiliation":[{"name":"Doctoral School, Department of General Medicine, \u201cVictor Babes\u201d University of Medicine and Pharmacy, Eftimie Murgu Square 2, 300041 Timisoara, Romania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0006-3896-9599","authenticated-orcid":false,"given":"Camelia-Oana","family":"Muresan","sequence":"additional","affiliation":[{"name":"Legal Medicine, Timisoara Institute of Legal Medicine, 300041 Timisoara, Romania"},{"name":"Ethics and Human Identification Research Center, \u201cVictor Babes\u201d University of Medicine and Pharmacy, Eftimie Murgu Square 2, 300041 Timisoara, Romania"},{"name":"Discipline of Forensic Medicine, Bioethics, Deontology, and Medical Law, Department of Neuroscience, \u201cVictor Babes\u201d University of Medicine and Pharmacy, Eftimie Murgu Square 2, 300041 Timisoara, Romania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ana-Olivia","family":"Toma","sequence":"additional","affiliation":[{"name":"Discipline of Dermatology, \u201cVictor Babes\u201d University of Medicine and Pharmacy, Eftimie Murgu Square 2, 300041 Timisoara, Romania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Stela","family":"Iurciuc","sequence":"additional","affiliation":[{"name":"Cardiology Department, \u201cVictor Babes\u201d University of Medicine and Pharmacy, Eftimie Murgu Square 2, 300041 Timisoara, Romania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Adrian-Cosmin","family":"Ilie","sequence":"additional","affiliation":[{"name":"Department of Public Health and Sanitary Management, \u201cVictor Babes\u201d University of Medicine and Pharmacy, Eftimie Murgu Square 2, 300041 Timisoara, Romania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Alexandra","family":"Enache","sequence":"additional","affiliation":[{"name":"Legal Medicine, Timisoara Institute of Legal Medicine, 300041 Timisoara, Romania"},{"name":"Ethics and Human Identification Research Center, \u201cVictor Babes\u201d University of Medicine and Pharmacy, Eftimie Murgu Square 2, 300041 Timisoara, Romania"},{"name":"Discipline of Forensic Medicine, Bioethics, Deontology, and Medical Law, Department of Neuroscience, \u201cVictor Babes\u201d University of Medicine and Pharmacy, Eftimie Murgu Square 2, 300041 Timisoara, Romania"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2025,11,18]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"450","DOI":"10.3390\/idr14030050","article-title":"Alveolar-Arterial Gradient Is an Early Marker to Predict Severe Pneumonia in COVID-19 Patients","volume":"14","author":"Pipitone","year":"2022","journal-title":"Infect. 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