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. 2022 Sep 15;11(18):5425.
doi: 10.3390/jcm11185425.

Lung Ultrasound Findings and Endothelial Perturbation in a COVID-19 Low-Intensity Care Unit

Roberta Gualtierotti  1   2 , Francesco Tafuri  2 , Raffaella Rossio  2 , Matteo Rota  3 , Paolo Bucciarelli  2 , Barbara Ferrari  2 , Andrea Giachi  1   2 , Chiara Suffritti  2 , Massimo Cugno  1   2 , Flora Peyvandi  1   2 , On Behalf Of The Principlus Study Group
Affiliations

Lung Ultrasound Findings and Endothelial Perturbation in a COVID-19 Low-Intensity Care Unit

Roberta Gualtierotti et al. J Clin Med. .

Abstract

Hypercoagulability and endothelial dysfunction related to inflammation have been clearly demonstrated in COVID-19. However, their influence on thromboembolism, lung alterations and mortality in low-intensity-care patients with COVID-19 is not completely clarified. Our aims were to evaluate the prevalence of deep vein thrombosis (DVT) with compressive ultrasound (CUS); to describe lung ultrasound (LUS) features; and to study coagulation, inflammatory and endothelial perturbation biomarkers in COVID-19 patients at low-intensity care unit admission. The predictive value of these biomarkers on mortality, need for oxygen support and duration of hospitalization was also evaluated. Of the 65 patients included, 8 were non-survivors. CUS was negative for DVT in all patients. LUS Soldati and Vetrugno scores were strongly correlated (rho = 0.95) with each other, and both significantly differed in patients who needed oxygen therapy vs. those who did not (Soldati p = 0.017; Vetrugno p = 0.023), with coalescent B lines as the most prevalent pattern in patients with a worse prognosis. Mean (SD) levels of thrombomodulin and VCAM-1 were higher in non-survivors than in survivors (7283.9 pg/mL (3961.9 pg/mL) vs. 4800.7 pg/mL (1771.0 pg/mL), p = 0.004 and 2299 ng/mL (730.35 ng/mL) vs. 1451 ng/mL (456.2 ng/mL), p < 0.001, respectively). Finally, in a multivariate analysis model adjusted for age, sex and Charlson score, VCAM-1 level increase was independently associated with death [OR 1.31 (1.06, 1.81; p = 0.036)]. In conclusion, in a cohort of mild COVID-19 patients, we found no DVT events despite the highly abnormal inflammatory, endothelial and coagulation parameters. The presence of lung alterations at admission could not predict outcome. The endothelial perturbation biomarker VCAM-1 emerged as a promising prognostic tool for mortality in COVID-19.

Keywords: COVID-19; compression ultrasound; endothelial perturbation; low-intensity care; lung ultrasound; thrombomodulin.

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Conflict of interest statement

The authors declare no conflict of interest.

Figures

Figure 1
Figure 1
Flow diagram of the enrolment of the study population.
See this image and copyright information in PMC

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