One-month outcomes of patients with SARS-CoV-2 infection and their relationships with lung ultrasound signs

Abstract

Background The role of lung ultrasound (LUS) in evaluating the mid- and long-term prognoses of patients with COVID-19 pneumonia is not yet known. The objectives of this study were to evaluate associations between LUS signs at the time of screening and clinical outcomes 1 month after LUS and to assess LUS signs at the time of presentation with known risk factors for COVID-19 pneumonia. Methods This was a retrospective study of data prospectively collected 1 month after LUS screening of 447 adult patients diagnosed with COVID-19 pneumonia. Sonographic examination was performed in screening tents with the participants seated. The LUS signs (B-lines > 2, coalescent B-lines, and subpleural consolidations) were captured in six areas of each hemithorax and a LUS aeration score was calculated; in addition, the categories of disease probability based on patterns of LUS findings (high-probability, intermediate-probability, alternate, and low-probability patterns) were evaluated. The LUS signs at patients’ initial evaluation were related to the following outcomes: symptomatology, the need for hospitalization or invasive mechanical ventilation (IMV), and COVID-19-related death. Results According to the evaluations performed 1 month after LUS screening, 36 patients were hospitalised, eight of whom required intensive care unit (ICU) admission and three of whom died. The presence of coalescent B-lines was associated with the need for hospitalization (p = 0.008). The presence of subpleural consolidations was associated with dyspnoea (p < 0.0001), cough (p = 0.003), the need for hospitalization (p < 0.0001), the need for ICU admission (p < 0.0001), and death (p = 0.002). A higher aeration score was associated with dyspnoea (p < 0.0001), the need for hospitalization (p < 0.0001), the need for ICU admission (p < 0.0001), and death (p = 0.003). In addition, patients with a high-probability LUS pattern had a higher aeration score (p < 0.0001) and more dyspnoea (p = 0.024) and more often required hospitalization (p < 0.0001) and ICU admission (p = 0.031). Conclusions In patients with COVID-19 pneumonia, LUS signs were related to respiratory symptoms 1 month after LUS screening. Strong relationships were identified between LUS signs and the need for hospitalization and death.

Importance of Lung Ultrasound Follow-Up in Patients Who Had Recovered from Coronavirus Disease 2019: Results from a Prospective Study

“…In addition, some studies have confirmed the relationship between the persistence of subpleural consolidations and the sensation of dyspnea [ 30 ].…”

Small airway dysfunction on impulse oscillometry and pathological signs on lung ultrasound are frequent in post-COVID-19 patients with persistent respiratory symptoms

“…With the participants in a sitting position, LUS signs were captured in six areas of each hemithorax as follows [ 25 ]: two anterior, two lateral, and two posterior. In the evaluation of the LUS pathological signs, we sought to identify B-lines >2, coalescent B-lines, and subpleural consolidations [ 8 ]. To obtain the aeration score, points were assigned to each of the six areas as follows: B-lines >2, 1 point; coalescent B-lines, 2 points; and consolidations, 3 points.…”

“…In this scenario, lung ultrasound (LUS) in the evaluation of patients with COVID-19 has been increasingly used and should be encouraged because it is a practical, low-cost, and radiation-free method, in addition to requiring equipment that is easy to clean [ 5 – 7 ]. With the increase in the number of studies, LUS has been shown to be a useful tool to monitor lung disease progression in patients with COVID-19, especially considering that SARS-CoV-2 preferentially affects peripheral areas of the lungs where visualization of LUS signs is quite satisfactory [ 8 , 9 ]. In addition, compared to CT, LUS appears to have an excellent discrimination capacity for the identification of pulmonary sequelae in post-COVID-19 follow-ups [ 7 ].…”

Outcomes of Simplified Lung Ultrasound Exam in COVID‐19: Implications for Self‐Imaging

“…Our unadjusted overall mortality rate of 29% for patients who had been imaged with ultrasound suggests a modest effect of selection bias, as this rate is high but comparable to that of unselected patients in similar-sized U.S. hospitals during the initial wave of the pandemic 37 and similar to other COVID-19 ultrasound outcome studies of older patients. [12][13][14] Concomitant cardiogenic pulmonary edema was not excluded and virus-induced heart failure exacerbation may have been a significant and prevalent comorbidity, 38 which was nonetheless considered attributable to the COVID-19 infection. As a single-center study, our findings represent the prevalence and virulence of cases encountered by a hospital in the downtown San Diego region which has a high proportion of admissions from the surrounding Hispanic community and an underserved homeless population and occurred before widespread vaccination, the appearance of the delta variant, and the development of any standardized outpatient treatments.…”