Lung ultrasound predicts clinical course and outcomes in COVID-19 patients

Abstract

Information regarding the use of lung ultrasound (LUS) in patients with Coronavirus disease 2019 (COVID-19) is quickly accumulating, but its use for risk stratification and outcome prediction has yet to be described. We performed the first systematic and comprehensive LUS evaluation of consecutive patients hospitalized with COVID-19 infection, in order to describe LUS findings and their association with clinical course and outcome. Methods: Between 21/03/2020 and 04/05/2020, 120 consecutive patients admitted to the Tel Aviv Medical Center due to COVID-19, underwent complete LUS within 24 h of admission. A second exam was performed in case of clinical deterioration. LUS score of 0 (best)-36 (worst) was assigned to each patient. LUS findings were compared with clinical data. Results: The median baseline total LUS score was 15, IQR [7-20]. Baseline LUS score was 0-18 in 80 (67%) patients, and 19-36 in 40 (33%) patients. The majority had patchy pleural thickening (n = 100; 83%), or patchy subpleural consolidations (n = 93; 78%) in at least one zone. The prevalence of pleural thickening, subpleural consolidations and the total LUS score were all correlated with severity of illness on admission. Clinical deterioration was associated with increased follow-up LUS scores (p = 0.0009), mostly due to loss of aeration in anterior lung segments. The optimal cutoff point for LUS score was 18 (sensitivity = 62%, specificity = 74%). Both mortality and need for invasive mechanical ventilation were increased with baseline LUS score > 18 compared to baseline LUS score 0-18. Unadjusted hazard ratio of death for LUS score was 1.08 per point [1.02-1.16], p = 0.008; Unadjusted hazard ratio of the composite endpoint (death or need for invasive mechanical ventilation) for LUS score was 1.12 per point [1.05-1.2], p = 0.0008. Conclusion: Hospitalized patients with COVID-19, at all clinical grades, present with pathological LUS findings. Baseline LUS score strongly correlates with the eventual need for invasive mechanical ventilation and is a strong predictor of mortality. Routine use of LUS may guide patients' management strategies, as well as resource allocation in case of surge capacity.

Lung ultrasonography: A prognostic tool in non-ICU hospitalized patients with COVID-19 pneumonia

“…As shown, literature on LUS in COVID-19 patients is rapidly growing; however few studies evaluated the prognostic value of LUS in COVID-19 patients [20] , [21] , [22] , [23] . All these studies enrolled a significant percentage of patients who were hospitalized in Intensive Care Units (ICU).…”

Development of a deep learning classifier to accurately distinguish COVID-19 from look-a-like pathology on lung ultrasound

“…23,28,29 Automating the detection of canonical findings of LUS, these techniques are convenient and serve to achieve what clinicians may be trained to do with minimal training. 30 With attention to COVID-19, LUS has been shown to inform clinical course and outcome 31 , creating some further momentum toward broader LUS competence. As our work opens the door toward plausible early, automated COVID identification using LUS, DL techniques to auto-generate clinical severity score for COVID has also recently been described.…”

Lungensonographie bei COVID‑19

“…In der sonographischen Darstellung dieser z. T. massiven und langstreckigen subpleuralen Konsolidierungen sind einige Besonderheiten bemerkenswert, die als Unterscheidungskriterien zu pneumonischen Infiltraten bakterieller Genese dienen können: gescannt wird (2 ventral, 2 lateral, 2 dorsal/Hemithorax) [11,17,18,22,38]. Da die meisten pathologischen Lungenveränderungen in den dorsobasalen Lungenabschnitten zu finden sind, dürfen diese Areale nicht unbeachtet bleiben [29,41,49].…”

“…Hier müssen die Vorteile der besseren Bildqualität und Möglichkeiten quantitativer Messungen gegen die Nachteile des aufwendigeren Desinfektionsprozesses für Monitor, Funktionsregler und Tastatur abgewogen werden. In Abhängigkeit von den zur Verfügung stehenden Ressourcen und der zu versorgenden Patientenzahl ist es empfehlenswert, ein geeignetes Ultraschallgerät eigens für den stationären Isolationsbereich abzustellen [5,15,33] [17,33,38]. Des Weiteren wird empfohlen, die Sonden mit einer langen, das Kabel inkludierenden Schutzhülle zu versehen [5,20,33].…”

“…Die Verbindung der lungensonographischen Befunde mit der Anamnese und klinischen Präsentation des Patienten und der Laborparameter erlauben dem behandelnden Arzt bereits bei der Erstuntersuchung eine orientierende Bewertung der klinischen Situation. Sowohl die Anzahl und Ausprägung der am weitesten fortgeschrittenen Konsolidierungen wie auch die Zusammenfassung der Befunde in einem Scoring-System können wertvolle Hinweise im Hinblick auf Schwere und Prognose der Erkrankung liefern [8,17,20,34,35]. Eine solche Bewertung kann jedoch nur dann vorgenommen werden, wenn alle Lungenanteile systematisch untersucht wurden.…”