Ultrasound findings in severe COVID-19: a deeper look through the carotid arteries

Bezerra, Camila Silva; Leite, Alice Abath; Costa, Thaís Ramos da; Lins, Esdras Marques; Godoi, Emmanuelle Tenório Albuquerque Madruga; Cordeiro, Lúcia Helena de Oliveira; Raposo, Maria Cristina Falcão; Brandão, Simone Cristina Soares

doi:10.1590/0100-3984.2022.0012

Acessibilidade / Reportar erro

Brasil

Español English

sumário « anterior atual seguinte »

Sumário

Original Article • Radiol Bras 55 (6) • Nov-Dec 2022 • https://doi.org/10.1590/0100-3984.2022.0012 copy

Ultrasound findings in severe COVID-19: a deeper look through the carotid arteries

Achados ultrassonográficos na COVID-19 grave: um olhar aprofundado baseado nas artérias carótidas

Authorship SCIMAGO INSTITUTIONS RANKINGS

Abstract

Objective:

To investigate vascular and perivascular abnormalities in the carotid arteries using ultrasound, as well as to evaluate their association with mortality and clinical variables in hospitalized patients with coronavirus disease 2019 (COVID-19).

Materials and Methods:

This was a prospective study in which 53 hospitalized patients with severe COVID-19 were evaluated and underwent carotid ultrasound. We documented the carotid ultrasound findings in these patients. Clinical, demographic, laboratory, and imaging features were analyzed and compared by statistical analysis to detect correlations between them.

Results:

Carotid ultrasound demonstrated luminal surface irregularity in 29 patients (55%), carotid plaques in 30 (57%), perivascular infiltration in four (8%), and increased intima–media thickness (IMT) in 31 (58%). Of the 31 patients with increased IMT, 19 (61%) died, and the association between increased IMT and COVID-19–related mortality was significant (p = 0.03). Logistic regression showed that the risk of death was 85% in patients who had increased IMT in combination with acute kidney injury at admission or a history of chronic kidney disease (p < 0.05).

Conclusion:

In hospitalized patients with severe COVID-19, carotid ultrasound can show increased IMT, luminal surface irregularity, carotid plaques, and perivascular infiltrates. The combination of increased IMT and kidney damage appears to increase the risk of death in such patients.

Keywords:
COVID-19; SARS-CoV-2; Ultrasonography; Carotid arteries; Carotid intima-media thickness

Characteristic	ICU (n = 43)	Non-ICU (n = 10)	P
Age, mean ± SD	59 ± 15	61 ± 15	0.90*
Sex, n (%)
Male	25 (82)	6 (18)	> 0.99^†
Female	18 (81)	4 (19)	> 0.99^†
Days from admission to outcome, mean ± SD Comorbidities, n (%)	22.8 ± 15.1	27.7 ± 22.4	0.65*
Hypertension	28 (65)	6 (60)	> 0.99^†
Diabetes	26 (60)	5 (50)	0.71^†
Asthma/COPD	9 (21)	2 (20)	> 0.99^†
Coronary disease	4 (9)	1 (10)	> 0.99^†
History of malignancy	9 (21)	2 (20)	> 0.99^†
Autoimmune disease	1 (2)	0 (0)	> 0.99^†
Kidney disease	22 (51)	2 (20)	0.09^†
HIV infection	1 (2)	2 (20)	0.08^†
Thrombotic complications, n (%)
History of stroke	4 (9)	0 (0)	> 0.99^†
In-hospital stroke	2 (5)	0 (0)	> 0.99^†
History of deep vein thrombosis	17 (50)	2 (20)	0.41^†
Invasive ventilation, n (%)	33 (77)	2 (22)	0.003^†
Outcome, n (%)
Discharge	19 (44)	8 (80)	0.07^†
Death	24 (56)	2 (20)	0.07^†

Variable	Outcome		Total	P
Variable	Discharge	Death	Total	P
Sex
Male, n (%)	12 (55)	10 (45)	22 (100)	0.19*
Female, n (%)	15 (48)	16 (52)	31 (100)	0.19*
Age, mean ± SD	57 ± 17	63 ± 11	60 ± 15	0.33^†
Type of hospitalization
ICU, n (%)	19 (44)	24 (56)	43 (100)	0.04*
Non-ICU, n (%)	8 (80)	2 (20)	10 (100)	0.04*
Hospital stay (days), mean ± SD	24.4 (20.4)	22.8 (11.4)	23.6 (16.3)	0.33^†
IMT
Yes, n (%)	12 (39)	19 (61)	31 (100)	0.03*
No, n (%)	15 (68)	7 (32)	22 (100)	0.03*
Luminal surface irregularity
Yes, n (%)	16 (55)	13 (45)	29 (100)	0.73*
No, n (%)	9 (50)	9 (50)	18 (100)	0.73*
Plaque(s)
Yes, n (%)	16 (53)	14 (47)	30 (100)	0.69*
No, n (%)	11 (48)	12 (52)	23 (100)	0.69*

Publicação do Colégio Brasileiro de Radiologia e Diagnóstico por Imagem Av. Paulista, 37 - 7º andar - conjunto 71, 01311-902 - São Paulo - SP, Tel.: +55 11 3372-4541, Fax: 3285-1690, Fax: +55 11 3285-1690 - São Paulo - SP - Brazil
E-mail: radiologiabrasileira@cbr.org.br

Acompanhe os números deste periódico no seu leitor de RSS

[1] Correspondence: Correspondence: Dra. Camila Silva Bezerra. Programa de Pós-Graduação em Cirurgia – Universidade Federal de Pernambuco (PPGC-UFPE), Hospital das Clínicas, Campus UFPE. Avenida Professor Moraes Rego, s/nº, Bloco A, Cidade Universitária. Recife, PE, Brazil, 50670-420. Email: camila.sbezerra@ufpe.br; camilasbezerra@hotmail.com.