Altered pulmonary blood volume distribution as a biomarker for predicting outcomes in COVID-19 disease

Abstract

BackgroundEvidence suggests that vascular inflammation and thrombosis may be important drivers of poor clinical outcomes in patients with COVID-19. We hypothesized that a significant decrease in the percentage of blood vessels with a cross-sectional area between 1.25–5 mm2 (BV5%) on chest computed tomography (CT) in COVID-19 patients is predictive of adverse clinical outcomes.MethodsRetrospective analysis of chest CT scans from 10 hospitals across two state in 313 COVID-19 positive and 195 COVID-19 negative patients seeking acute medical care.ResultsBV5% was predictive of outcomes in COVID-19 patients in a multivariate model, with a BV5% threshold below 25% associated with an odds ratio (OR) 5.58 for death, OR 3.20 for intubation, and OR 2.54 for the composite of death or intubation. A model using age and BV5% had an area under the receiver operating characteristic curve 0.85 to predict the composite of intubation or death in COVID-19 patients. BV5% was not predictive of clinical outcomes in patients without COVID-19.ConclusionThis data suggests BV5% as a novel biomarker for predicting adverse outcomes in patients with COVID-19 seeking acute medical care.

How and to What Extent Immunological Responses to SARS-CoV-2 Shape Pulmonary Function in COVID-19 Patients

“…A low TLCO is not exclusively determined by reduced VA ( Nusair, 2020 ), and residual interstitial anomalies ( Chen et al, 2020 ; Mo et al, 2020 ; Qin et al, 2021 ) and pulmonary vascular anomalies (i.e., abnormal capillary-alveolar units) ( Morris et al, 2021 ) may play a fundamental role and this could be also the case in COVID-19 survivors ( Figures 2A , B ). This holds true as the interpretation of low TLCO must consider the complex relationship between VA, TLCO and KCO, and may inopportunely exclude the presence of abnormal gas exchange in the lung ( Figures 2A , B ).…”

“…The consequence would be a decrease in both VA and KCO (for that diminished VA). There is mounting evidence for impaired pulmonary hemodynamics in COVID-19 patients ( Potus et al, 2020 ), including vascular pruning, decreased pulmonary blood volume and abnormal pulmonary blood volume distribution as measured via high resolution CT ( Lins et al, 2020 ; Morris et al, 2021 ). Figures 2A , B shows that a decrease in KCO may develop in the context of alveolar-capillary damage, microvascular pathology, or anemia.…”

“…Few studies have explored some “predictors” for lung function decline, especially for TLCO. Pulmonary interstitial damage (inferred to by the Chest CT total severity score), the development of acute respiratory distress syndrome, and vascular damage (inferred to by the high D-dimer levels at the time of hospital admission) have been pointed out as potential predictors for lung function decline, especially for TLCO but also for TLC ( Morris et al, 2021 ; Qin et al, 2021 ).…”

Pulmonary vascular involvement in COVID‐19 pneumonitis: Is this the first and final insult?

“…Studies at 6 months indicate that interstitial abnormalities on CT are common 1 . Pulmonary vascular volume is reduced 12 and microvascular imaging using both lung magnetic resonance and DECT suggests that perfusion defects are common at follow‐up 13,14 . The relative contributions of long‐term interstitial and vascular abnormalities to persistent breathlessness remain uncertain, but lone vascular defects are increasingly recognized (Figure 1B,C).…”

Microvascular Injury With Secondary Edema, Bronchoconstriction and Vasoconstriction of Non-involved Lung Parenchymal Segments May Contribute to Clinical Deterioration of Non-critically Ill Patients Hospitalized for SARS-CoV-2 Pneumonia Without Evidence of Pulmonary Embolism: A Preliminary Study.

“…To our knowledge, such an edema in non-critically ill patients has never been evidenced in vivo. Additionally, the attenuation of small blood vessels is not speci c of SARS-CoV-2-related pneumonia and occurs in any community-acquired pneumonia [11,12]. Indeed, studies of CTPA combined with arti cial intelligence [11,12] have shown a lessering of pulmonary micro-vessels (below 5 mm 2 ) in patients with COVID-19 as well as in community-acquired pneumonia, this decrease being a prognostic factor for the risk of mechanical ventilation or death [11].…”