ATS 2021 will feature presentations of original research from accepted abstracts. Mini Symposia and Thematic Poster Sessions are abstract based sessions.
Please use the form below to browse scientific abstracts and case reports accepted for ATS 2021. Abstracts presented at the ATS 2021 will be published in the Online Abstract Issue of the American Journal of Respiratory and Critical Care Medicine, Volume 203, May 3, 2021.
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Association of Serum D-Dimer and Abnormal Pulmonary Vasculature on CT Scan During Hospitalization with Decreased Diffusion Capacity in Follow Up for COVID-19 Infection
Session Title
TP117 - TP117 COVID-19 PATHOPHYSIOLOGY AND MODELLING
Abstract
A4465 - Association of Serum D-Dimer and Abnormal Pulmonary Vasculature on CT Scan During Hospitalization with Decreased Diffusion Capacity in Follow Up for COVID-19 Infection
Author Block: I. Oriaku1, M. Darnell1, J. Mokha1, M. Lanclus2, J. De Backer2, B. Lavon2, R. Gupta1, F. Jaffe1, M. Vega Sanchez1, D. Salerno1, V. Kim1; 1Department of Thoracic Medicine and Surgery, Lewis Katz School of Medicine, Temple University Hospital, Philadelphia, PA, United States, 2Fluidda, New York, NY, United States.
Rationale: Coronavirus Disease 2019 (COVID-19) is a highly contagious respiratory viral illness causing pneumonia and systemic disease. Abnormalities in pulmonary function after COVID-19 infection have been described. The determinants of these abnormalities are unclear. We hypothesized that inflammatory biomarkers and computed tomography (CT) scan parameters at the time of infection would be associated with abnormal gas exchange at short term follow-up.Methods: We studied subjects who were hospitalized for COVID-19 pneumonia and then discharged. Those with pre-existing lung disease (except asthma) or reduced diffusing capacity for carbon monoxide (DLCO) prior to COVID-19 infection were excluded. Information on serum inflammatory biomarkers, CT scan, and clinical characteristics were collected in the index hospitalization. Pulmonary function tests and 6-minute walk tests were assessed at 2-3 months after discharge. CT images at the time of hospitalization were evaluated by Functional Respiratory Imaging (FRI; FLUIDDA, Inc., Antwerp, Belgium) with 3D reconstruction of the lungs and pulmonary vasculature to analyze pulmonary blood volume. Blood volumes of the pulmonary vessels that were ≤5mm (BV5), 5-10mm (BV5_10), and ≥10mm (BV10) in cross-sectional area were analyzed. Additionally, the amount of inflammation on CT (ground-glass opacities) was quantified. We divided subjects into those with a DLCO <80% predicted and those with a DLCO ≥80% predicted based on follow-up pulmonary function tests. Results: 38 subjects were included in our cohort. Pulmonary function tests were performed 76.5±35.1 days after the first day of hospitalization. The results are summarized in the Table. 31 out of 38 (81.5%) subjects had a DLCO<80% predicted. The groups were similar in terms of demographics, body mass index, and smoking status. Peak D-dimer, LDH, and ferritin levels were greater in the DLCO<80% group. Spirometric measures and lung volumes were similar between groups. Inflammation was not different between groups, but BV5_10 and BV10 measures were higher in the DLCO<80% group. BV5_10 was associated with DLCO<80% in multivariable logistic regression with demographics, smoking status, lung volumes, and hemoglobin as covariates (OR 1.29, 95% CI 1.01, 1.64).Conclusions: Higher peak D-dimer levels at the time of hospitalization and abnormalities in pulmonary blood volumes are associated with a reduced DLCO at follow-up. These findings suggest that pulmonary vascular and coagulation abnormalities during hospitalization with COVID-19 might have long-lasting effects on pulmonary function. Further study regarding the influence of pulmonary blood volumes and measures of abnormal coagulation on short term COVID-19 outcomes is warranted. Funding statement: Image analyses were funded by Fluidda’s COVID19 consortium.
Author Block: I. Oriaku1, M. Darnell1, J. Mokha1, M. Lanclus2, J. De Backer2, B. Lavon2, R. Gupta1, F. Jaffe1, M. Vega Sanchez1, D. Salerno1, V. Kim1; 1Department of Thoracic Medicine and Surgery, Lewis Katz School of Medicine, Temple University Hospital, Philadelphia, PA, United States, 2Fluidda, New York, NY, United States.
Rationale: Coronavirus Disease 2019 (COVID-19) is a highly contagious respiratory viral illness causing pneumonia and systemic disease. Abnormalities in pulmonary function after COVID-19 infection have been described. The determinants of these abnormalities are unclear. We hypothesized that inflammatory biomarkers and computed tomography (CT) scan parameters at the time of infection would be associated with abnormal gas exchange at short term follow-up.Methods: We studied subjects who were hospitalized for COVID-19 pneumonia and then discharged. Those with pre-existing lung disease (except asthma) or reduced diffusing capacity for carbon monoxide (DLCO) prior to COVID-19 infection were excluded. Information on serum inflammatory biomarkers, CT scan, and clinical characteristics were collected in the index hospitalization. Pulmonary function tests and 6-minute walk tests were assessed at 2-3 months after discharge. CT images at the time of hospitalization were evaluated by Functional Respiratory Imaging (FRI; FLUIDDA, Inc., Antwerp, Belgium) with 3D reconstruction of the lungs and pulmonary vasculature to analyze pulmonary blood volume. Blood volumes of the pulmonary vessels that were ≤5mm (BV5), 5-10mm (BV5_10), and ≥10mm (BV10) in cross-sectional area were analyzed. Additionally, the amount of inflammation on CT (ground-glass opacities) was quantified. We divided subjects into those with a DLCO <80% predicted and those with a DLCO ≥80% predicted based on follow-up pulmonary function tests. Results: 38 subjects were included in our cohort. Pulmonary function tests were performed 76.5±35.1 days after the first day of hospitalization. The results are summarized in the Table. 31 out of 38 (81.5%) subjects had a DLCO<80% predicted. The groups were similar in terms of demographics, body mass index, and smoking status. Peak D-dimer, LDH, and ferritin levels were greater in the DLCO<80% group. Spirometric measures and lung volumes were similar between groups. Inflammation was not different between groups, but BV5_10 and BV10 measures were higher in the DLCO<80% group. BV5_10 was associated with DLCO<80% in multivariable logistic regression with demographics, smoking status, lung volumes, and hemoglobin as covariates (OR 1.29, 95% CI 1.01, 1.64).Conclusions: Higher peak D-dimer levels at the time of hospitalization and abnormalities in pulmonary blood volumes are associated with a reduced DLCO at follow-up. These findings suggest that pulmonary vascular and coagulation abnormalities during hospitalization with COVID-19 might have long-lasting effects on pulmonary function. Further study regarding the influence of pulmonary blood volumes and measures of abnormal coagulation on short term COVID-19 outcomes is warranted. Funding statement: Image analyses were funded by Fluidda’s COVID19 consortium.
