Venous Thromboembolism and Lung Ultrasound Findings With COVID-19

In a recent study, patients who were hospitalized with COVID-19 frequently showed pathological findings on lung ultrasound (LUS), with LUS findings associated with the development of venous thromboembolism (VTE). The study results were published in the Journal of Ultrasound.

This multicenter, prospective trial was the ECHOVID-19 study (ClinicalTrials.gov Identifier: NCT04377035), which was based in Eastern Denmark and included hospitalized patients with COVID-19. Patients were evaluated by 8-zone LUS, with LUS score, B-line score, and total number of B-lines evaluated. VTE was the primary study outcome, and this was defined as an incident of pulmonary embolism confirmed by computed tomography or deep vein thrombosis confirmed by ultrasound.

A total of 203 adult patients were examined in this study. Patients showed COVID-19 symptoms for a median of 7 days (interquartile range [IQR], 3-10) before admission. LUS examination occurred at a median of 4 days (IQR, 2-8) after admission. Patients had a median LUS score of 3 (IQR, 1-5) and a median of 12 (IQR, 8-18) B-lines. A positive B-line score was shown for 22% of patients.

VTE occurred in 17 patients while hospitalized, with 15 patients experiencing pulmonary embolism, and deep vein thrombosis developing in 4 patients. Patients with VTE underwent a median of 9 days (IQR, 5-17) from hospitalization to VTE. A total of 12 of the VTEs appeared after LUS, and 5 occurred before ultrasound.

In multivariable, adjusted Cox regression analyses, all examined LUS features showed significant associations with VTE; these analyses excluded patients with VTE present prior to LUS. With a positive B-line score, the hazard ratio (HR) for VTE was 9.79 (95% CI, 1.87-51.35; P =.007). For the total number of B-lines, the HR for VTE was 1.14 (95% CI, 1.03-1.26; P =.016) for every incremental B-line increase. For every 1-point rise in LUS score, the HR for VTE was 1.51 (95% CI, 1.10-2.07; P =.01).

Overall, the study authors noted that LUS findings appeared to be common in the context of COVID-19 hospitalization, and that LUS score, total number of B-lines, and B-line score showed significant associations with VTE in hospitalized patients. However, LUS score was not significantly associated with ventricular parameters evaluated by echocardiography.

The study authors concluded that pathological observations on LUS occurred commonly in patients hospitalized with COVID-19, and that LUS parameters examined in this study were associated with VTE. “These findings indicate that the LUS examination may be useful in risk stratification and the clinical management of COVID-19,” they wrote in their report. They considered the study results to be hypothesis generating.

Disclosures: Some authors have declared affiliations with or received grant support from the pharmaceutical industry. Please refer to the original study for a full list of disclosures.

Reference

Skaarup KG, Lassen MCH, Espersen C, et al. Lung ultrasound findings in hospitalized COVID‑19 patients in relation to venous thromboembolic events: the ECHOVID‑19 study. J Ultrasound. doi:10.1007/s40477-021-00605-8

This article originally appeared on Hematology Advisor