Lung ultrasound and coagulation activation in COVID-19 pneumonia

To evaluate the correlation between the degree of pulmonary compromise, as assessed by lung ultrasound, and the activation of the coagulation cascade in patients hospitalized with COVID-19 pneumonia.

A prospective observational study was conducted on 47 adult patients with confirmed COVID-19 pneumonia. Each patient underwent a systematic 12-zone LUS exam to calculate a total Lung Ultrasound Score (LUS score). Arterial blood gas analysis was performed to calculate the arterial partial pressure of oxygen to fraction of inspired oxygen (P/F) ratio and the alveolar-arterial (A-a) oxygen gradient. Laboratory tests included serum D-dimer and C-reactive protein (CRP).

The LUS score correlated positively and significantly with D-dimer values (p = 0.019; ρ = 0.342), CRP (p < 0.001; ρ = 0.647), and the A-a gradient (p < 0.001; ρ = 0.640). It also displayed a significant negative correlation with the P/F ratio (p < 0.001; ρ = -0.614).

The degree of lung injury in COVID-19 pneumonia, as evaluated by LUS, correlates directly with elevated D-dimer levels, signifying increased coagulation activation. Lung ultrasound, as a bedside and noninvasive tool, could serve as a surrogate marker not only for pulmonary involvement but also for identifying patients at higher risk of thrombotic complications.