Integrated Analysis of Parenchymal and Vascular HRCT Patterns with Circulating Biomarkers in Severe COVID-19 Pneumonia

<b>Purpose</b>: To explore the correlation between radiologic patterns on high-resolution computed tomography (HRCT) and circulating biomarkers of inflammation and endothelial activation in patients with COVID-19 pneumonia, with the aim of identifying imaging-biomarker phenotypes that may offer insights for clinical stratification. <b>Materials and Methods</b>: This prospective single-center study included 84 consecutive patients hospitalized with PCR-confirmed SARS-CoV-2 infection and respiratory failure. All underwent baseline HRCT, along with parallel biohumoral profiling, including inflammatory (IL-1Ra, IL-6, IL-10) and endothelial (Angiopoietin-2, sVCAM-1, sE-Selectin) biomarkers. HRCT scans were reviewed for parenchymal and vascular abnormalities (vascular tree-in-bud [TIB], vascular enlargement pattern [VEP]). Semi-quantitative scores were assigned for parenchymal (PS) and vascular (VS) involvement. <b>Results</b>: Patients with higher PS had significantly prolonged hospital stay (35 vs. 17 days; <i>p</i> = 0.014), increased ICU admission rates (68.8% vs. 21.4%; <i>p</i> = 0.003), and elevated serum levels of IL-1Ra, IL-6, and IL-10 (<i>p</i> < 0.05). At multivariable analysis, PS remained independently associated with ICU admission after adjustment for age, inflammatory burden, and comorbidities (<i>p</i> = 0.014). A high VS was associated with significantly increased Angiopoietin-2 levels (<i>p</i> = 0.036), although it did not directly correlate with ICU admission or mortality. A significant positive correlation was observed between PS and VS (r =0.392; <i>p</i> < 0.001). <b>Conclusions</b>: in this study, HRCT-based parenchymal and vascular patterns appear significantly correlated with biological processes occurring in severe COVID-19 pneumonia. These observations, although preliminary, may offer a conceptual basis for future studies exploring radiologic and biomarker-based stratification in severe respiratory infections.