Point-of-Care Lung Ultrasound Predicts Severe Disease and Death Due to COVID-19: A Prospective Cohort Study

Abstract

The clinical utility of point-of-care lung ultrasound (LUS) among hospitalized patients with COVID-19 is unclear.DESIGN: Prospective cohort study. SETTING:A large tertiary care center in Maryland, between April 2020 and September 2021. PATIENTS:Hospitalized adults (≥ 18 yr old) with positive severe acute respiratory syndrome coronavirus 2 reverse transcriptase-polymerase chain reaction results. INTERVENTIONS: None. MEASUREMENTS AND MAIN RESULTS:All patients were scanned using a standardized protocol including 12 lung zones and followed to determine clinical outcomes until hospital discharge and vital status at 28 days. Ultrasounds were independently reviewed for lung and pleural line artifacts and abnormalities, and the mean LUS Score (mLUSS) (ranging from 0 to 3) across lung zones was determined. The primary outcome was time to ICU-level care, defined as high-flow oxygen, noninvasive, or invasive mechanical ventilation, within 28 days of the initial ultrasound. Cox proportional hazards regression models adjusted for age and sex were fit for mLUSS and each ultrasound covariate. A total of 264 participants were enrolled in the study; the median age was 61 years and 114 participants (43.2%) were female. The median mLUSS was 1.0 (interquartile range, 0.5-1.3). Following enrollment, 27 participants (10.0%) went on to require ICU-level care, and 14 (5.3%) subsequently died by 28 days. Each increase in mLUSS at enrollment was associated with disease progression to ICU-level care (adjusted hazard ratio [aHR], 3.61; 95% CI, 1.27-10.2) and 28-day mortality (aHR, 3.10; 95% CI,. Pleural line abnormalities were independently associated with disease progression to death (aHR, 20.93; CI,. CONCLUSIONS:Participants with a mLUSS greater than or equal to 1 or pleural line changes on LUS had an increased likelihood of subsequent requirement of high-flow oxygen or greater. LUS is a promising tool for assessing risk of COVID-19 progression at the bedside.

Additive value of lung ultrasound to clinical parameters for prognosticating COVID-19

“…Methods including participant enrollment, lung ultrasound acquisition and quality assurance and control have been previously described. 6 Ethical approval was obtained from the Johns Hopkins University Institutional Review Board (IRB00245545).…”

Do worsening lung ultrasound scans identify severe COVID-19 trajectories?

“…This protocol was approved by the Johns Hopkins University Institutional Review Board (IRB00245545). After screening SARS-CoV-2 RT-PCR positive patients, a convenience sample of 264 patients were enrolled depending on LUS-trained research staff availability as previously described ( 1 ). After enrollment, study visits including LUS scans occurred until hospital discharge on study days 3, 7, and weekly for up to 90 days from enrollment.…”

“…As described ( 1 ), lung images were collected using 6-s clips from 12 zones using a Lumify S4 phase array probe (Philips, Amsterdam, Netherlands). Study personnel were subsequently masked to clinical information and provided reads identifying and characterizing A-lines (an indicator of normal lung), B-lines (an indicator of edema, fibrosis, or inflammation), consolidations, pleural effusions, and pleural line thickening.…”

“…Therefore, the mean LUS (mLUS) score was calculated, including those with less than a full 12-zone exam. This composite score (ranging from 0 to 3 with a higher score signifying higher severity) is an average across zones with 1 point for discrete B-lines, 2 points for coalescent B-lines, and 3 points for lung consolidation as previously described ( 1 ). Mean number of lung zones scanned across all participants and visits was 5.6.…”

“…While multiple studies (1)(2)(3)(4)(5) have assessed the prognostic value of LUS, few (6,7) have assessed changes over time in a methodical manner. In addition to identifying resolving of severe pulmonary disease, changes in LUS findings could help monitor patient trajectories.…”