Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2024 Feb 14;14(4):421.
doi: 10.3390/diagnostics14040421.

Correlation between Serum Biomarkers and Lung Ultrasound in COVID-19: An Observational Study

Amne Mousa  1   2 , Siebe G Blok  2   3 , Dian Karssen  1 , Jurjan Aman  4 , Jouke T Annema  4 , Harm Jan Bogaard  4 , Peter I Bonta  4 , Mark E Haaksma  1   2 , Micah L A Heldeweg  1   2 , Arthur W E Lieveld  5 , Prabath Nanayakkara  5 , Esther J Nossent  4 , Jasper M Smit  1   2 , Marry R Smit  3 , Alexander P J Vlaar  3 , Marcus J Schultz  3 , Lieuwe D J Bos  3 , Frederique Paulus  3 , Pieter R Tuinman  1   2 , Amsterdam Umc Covid-Biobank Investigators
Affiliations

Correlation between Serum Biomarkers and Lung Ultrasound in COVID-19: An Observational Study

Amne Mousa et al. Diagnostics (Basel). .

Abstract

Serum biomarkers and lung ultrasound are important measures for prognostication and treatment allocation in patients with COVID-19. Currently, there is a paucity of studies investigating relationships between serum biomarkers and ultrasonographic biomarkers derived from lung ultrasound. This study aims to assess correlations between serum biomarkers and lung ultrasound findings. This study is a secondary analysis of four prospective observational studies in adult patients with COVID-19. Serum biomarkers included markers of epithelial injury, endothelial dysfunction and immune activation. The primary outcome was the correlation between biomarker concentrations and lung ultrasound score assessed with Pearson's (r) or Spearman's (rs) correlations. Forty-four patients (67 [41-88] years old, 25% female, 52% ICU patients) were included. GAS6 (rs = 0.39), CRP (rs = 0.42) and SP-D (rs = 0.36) were correlated with lung ultrasound scores. ANG-1 (rs = -0.39) was inversely correlated with lung ultrasound scores. No correlations were found between lung ultrasound score and several other serum biomarkers. In patients with COVID-19, several serum biomarkers of epithelial injury, endothelial dysfunction and immune activation correlated with lung ultrasound findings. The lack of correlations with certain biomarkers could offer opportunities for precise prognostication and targeted therapeutic interventions by integrating these unlinked biomarkers.

Keywords: COVID-19; SARS-CoV-2; endothelial dysfunction; epithelial injury; immune activation; lung; respiratory failure; ultrasonography.

PubMed Disclaimer

Conflict of interest statement

The authors declare no conflicts of interest.

Figures

Figure A1
Figure A1
Correlation between serum biomarkers and lung ultrasound score. C: Complement component. CD: Cluster of differentiation. CRP: C-reactive protein. GAS: Growth arrest specific. IL: Interleukin. sRAGE: Soluble receptor for advanced glycation. SP-D: Surfactant protein-D. TNF: Tumor necrosis factor. uPAR: Urokinase-type plasminogen activator receptor. VCAM-1: Vascular cell adhesion protein 1.vWF: von Willebrand factor.
Figure A1
Figure A1
Correlation between serum biomarkers and lung ultrasound score. C: Complement component. CD: Cluster of differentiation. CRP: C-reactive protein. GAS: Growth arrest specific. IL: Interleukin. sRAGE: Soluble receptor for advanced glycation. SP-D: Surfactant protein-D. TNF: Tumor necrosis factor. uPAR: Urokinase-type plasminogen activator receptor. VCAM-1: Vascular cell adhesion protein 1.vWF: von Willebrand factor.
Figure A2
Figure A2
Biomarker levels in patients with different lung profiles. The white circles depict the outliers.ANG: Angiopoietin. C: Complement component. CD: Cluster of differentiation. GAS: Growth arrest specific. IL: Interleukin. PTX: Pentraxin. sRAGE: Soluble receptor for advanced glycation. SP-D: Surfactant protein-D. TNF: Tumor necrosis factor. uPAR: Urokinase-type plasminogen activator receptor. VCAM-1: Vascular cell adhesion protein 1.vWF: von Willebrand factor.
Figure A3
Figure A3
Biomarker levels in patients with normal and abnormal pleural characteristics. The white circles depict the outliers.ANG: Angiopoietin. C: Complement component. CD: Cluster of differentiation. CRP: C-reactive protein. GAS: Growth arrest specific. IL: Interleukin. PTX: Pentraxin. RAGE: Receptor for advanced glycation. TNF: Tumor necrosis factor. uPAR: Urokinase-type plasminogen activator receptor. VCAM-1: Vascular cell adhesion protein 1.
Figure 1
Figure 1
Correlation coefficients with 95% confidence intervals between lung ultrasound score and biomarkers for the overall cohort, ward patients and ICU patients. Black dots indicate statistical significant correlation coefficient (p < 0.05). ANG: Angiopoietin. C: Complement component. CD: Cluster of differentiation. CRP: C-reactive protein. GAS: Growth arrest specific. IL: Interleukin. PTX-3: Pentraxin-3. sRAGE: Soluble receptor for advanced glycation. SP-D: Surfactant protein-D. TNF: Tumor necrosis factor. uPAR: Urokinase-type plasminogen activator receptor. VCAM-1: Vascular cell adhesion protein 1. vWF: von Willebrand factor.
Figure 2
Figure 2
Biomarker levels in patients with different lung ultrasound profiles. The white circles depict the outliers. * indicates p-value < 0.05, ** indicates p-value < 0.01, ns indicates not significant. CRP: C-reactive protein; IL: interleukin; TNF: tumor necrosis factor.
Figure 3
Figure 3
Biomarker levels in patients with normal and abnormal pleural characteristics. The white circles depict the outliers. D: Complement component. SP-D: Surfactant protein-D. TNF: tumor necrosis factor; vWF: von Willebrand factor.
See this image and copyright information in PMC

References

    1. Lu S., Huang X., Liu R., Lan Y., Lei Y., Zeng F., Tang X., He H. Comparison of COVID-19 Induced Respiratory Failure and Typical ARDS: Similarities and Differences. Front. Med. 2022;9:829771. doi: 10.3389/fmed.2022.829771. - DOI - PMC - PubMed
    1. Du R.H., Liang L.R., Yang C.Q., Wang W., Cao T.Z., Li M., Guo G.Y., Du J., Zheng C.L., Zhu Q., et al. Predictors of mortality for patients with COVID-19 pneumonia caused by SARS-CoV-2: A prospective cohort study. Eur. Respir. J. 2020;7:2000524. doi: 10.1183/13993003.00524-2020. - DOI - PMC - PubMed
    1. Laing A.G., Lorenc A., Del Molino Del Barrio I., Das A., Fish M., Monin L., Muñoz-Ruiz M., McKenzie D., Hayday T.S., Francos-Quijorna I., et al. A dynamic COVID-19 immune signature includes associations with poor prognosis. Nat. Med. 2020;26:1623–1635. doi: 10.1038/s41591-020-1038-6. - DOI - PubMed
    1. Matthay M.A., Arabi Y.M., Siegel E.R., Ware L.B., Bos L.D.J., Sinha P., Beitler J.R., Wick K.D., Curley M.A.Q., Constantin J.M., et al. Phenotypes and personalized medicine in the acute respiratory distress syndrome. Intensive Care Med. 2020;46:2136–2152. doi: 10.1007/s00134-020-06296-9. - DOI - PMC - PubMed
    1. Frank A.J., Thompson B.T. Pharmacological treatments for acute respiratory distress syndrome. Curr. Opin. Crit. Care. 2010;16:62–68. doi: 10.1097/MCC.0b013e328334b151. - DOI - PubMed