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

Thiago Thomaz Mafort, Rogério Rufino, Claudia Henrique da Costa, Mariana Soares da Cal, Laura Braga Monnerat, Patrícia Frascari Litrento, Laura Lizeth Zuluaga Parra, Arthur de Sá Earp de Souza Marinho, Agnaldo José Lopes, Thiago Thomaz Mafort, Rogério Rufino, Claudia Henrique da Costa, Mariana Soares da Cal, Laura Braga Monnerat, Patrícia Frascari Litrento, Laura Lizeth Zuluaga Parra, Arthur de Sá Earp de Souza Marinho, Agnaldo José Lopes

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.

Keywords: 1-month outcomes; COVID-19; Lung ultrasound; Pneumonia; SARS-CoV-2.

Conflict of interest statement

The authors declare no conflicts of interest.

Figures

Fig. 1
Fig. 1
Representation of the 12 zones on the chest. a The anterior and axillary zones; b the posterior zones. The zones 1 and 2 are limited by the parasternal and anterior axillary lines. The zones 3 and 4 are limited by the anterior axillary and posterior axillary lines. Finally, the zones 5 and 6 are limited by the paravertebral and posterior axillary lines and by the contour of the scapula
Fig. 2
Fig. 2
Relationships between the presence of subpleural consolidation on lung ultrasound and the outcomes of a hospitalization (p < 0.0001) and b death (p = 0.002)
Fig. 3
Fig. 3
Relationships between the aeration score on lung ultrasound and the outcomes of a hospitalization (p < 0.0001) and b death (p = 0.003)

References

    1. Chen N, Zhou M, Dong X, et al. Epidemiological and clinical characteristics of 99 cases of 2019 novel coronavirus pneumonia in Wuhan, China: a descriptive study. Lancet. 2020;395:507–513. doi: 10.1016/S0140-6736(20)30211-7.
    1. Allinovi M, Parise A, Giacalone M, et al. Lung ultrasound may support diagnosis and monitoring of COVID-19 pneumonia. Ultrasound Med Biol. 2020;46:2908–2917. doi: 10.1016/j.ultrasmedbio.2020.07.018.
    1. George PM, Barratt SL, Condliffe R, et al. Respiratory follow-up of patients with COVID-19 pneumonia. Thorax. 2020;75:1009–1016. doi: 10.1136/thoraxjnl-2020-215314.
    1. Mo X, Jian W, Su Z, et al. Abnormal pulmonary function in COVID-19 patients at time of hospital discharge. Eur Respir J. 2020;55:2001217. doi: 10.1183/13993003.01217-2020.
    1. Smargiassi A, Soldati G, Torri E, et al. Lung ultrasound for COVID-19 patchy pneumonia. J Ultrasound Med. 2021;40:521–528. doi: 10.1002/jum.15428.
    1. Fonsi GB, Sapienza P, Brachini G, et al. Is lung ultrasound imaging a worthwhile procedure for severe acute respiratory syndrome coronavirus 2 pneumonia detection? J Ultrasound Med. 2020 doi: 10.1002/jum.15487.
    1. Zhu F, Zhao X, Wang T, et al. Ultrasonic characteristics and severity assessment of lung ultrasound in COVID-19 pneumonia in Wuhan, China: a retrospective, observational study. Engineering. 2020 doi: 10.1016/j.eng.2020.09.007.
    1. Lopes AJ, Mafort TT, da Costa CH, et al. Comparison between lung ultrasound and computed tomographic findings in patients with COVID-19 pneumonia. J Ultrasound Med. 2020 doi: 10.1002/jum.15521.
    1. Mafort TT, Lopes AJ, da Costa CH, et al. Changes in lung ultrasound of symptomatic healthcare professionals with COVID-19 pneumonia and their association with clinical findings. J Clin Ultrasound. 2020;48:515–521. doi: 10.1002/jcu.22905.
    1. Zieleskiewicz L, Markarian T, Lopez A, et al. Comparative study of lung ultrasound and chest computed tomography scan in the assessment of severity of confirmed COVID-19 pneumonia. Intensive Care Med. 2020;46:1707–1713. doi: 10.1007/s00134-020-06186-0.
    1. Perrone T, Soldati G, Padovini L. A new lung ultrasound protocol able to predict worsening in patients affected by severe acute respiratory syndrome coronavirus 2 pneumonia. J Ultrasound Med. 2020 doi: 10.1002/jum.15548.
    1. Hussain A, Via G, Melniker L, et al. Multi-organ point-of-care ultrasound for COVID-19 (PoCUS4COVID): international expert consensus. Crit Care. 2020;24:702. doi: 10.1186/s13054-020-03369-5.
    1. Bernheim A, Mei X, Huang M, et al. Chest CT findings in coronavirus disease-19 (COVID-19): relationship to duration of infection. Radiology. 2020;295:200463. doi: 10.1148/radiol.2020200463.
    1. Sultan LR, Sehgal CM. A review of early experience in lung ultrasound in the diagnosis and management of COVID-19. Ultrasound Med Biol. 2020;46:2530–2545. doi: 10.1016/j.ultrasmedbio.2020.05.012.
    1. Gaspardone C, Meloni C, Preda A, et al. Lung ultrasound in COVID-19 a role beyond the acute phase? J Ultrasound Med. 2021;40:503–511. doi: 10.1002/jum.15425.
    1. Soummer A, Perbet S, Brisson H, et al. Ultrasound assessment of lung aeration loss during a successful weaning trial predicts postextubation distress. Crit Care Med. 2012;40:2064–2072. doi: 10.1097/CCM.0b013e31824e68ae.
    1. Tung-Chen Y, Algora-Martín A, Llamas-Fuentes R, et al. Point-of-care ultrasonography in the initial characterization of patients with COVID-19. Med Clin. 2021 doi: 10.1016/j.medcli.2020.12.007.
    1. Saraogi A. Lung ultrasound: present and future. Lung India. 2015;32:250–257. doi: 10.4103/0970-2113.156245.
    1. Tung-Chen Y, de Gracia MM, Díez-Tascón A, et al. Correlation between chest computed tomography and lung ultrasonography in patients with coronavirus disease 2019 (COVID-19) Ultrasound Med Biol. 2020;46:2918–2926. doi: 10.1016/j.ultrasmedbio.2020.07.003.
    1. Volpicelli G, Lamorte A, Villén T. What's new in lung ultrasound during the COVID-19 pandemic. Intensive Care Med. 2020;46:1445–1448. doi: 10.1007/s00134-020-06048-9.
    1. Millington SJ, Koenig S, Mayo P, et al. Lung ultrasound for patients with coronavirus disease 2019 pulmonary disease. Chest. 2021;159:205–211. doi: 10.1016/j.chest.2020.08.2054.
    1. Volpicelli G, Gargani L, Perlini S, et al. Lung ultrasound for the early diagnosis of COVID-19 pneumonia: an international multicenter study. Intensive Care Med. 2021 doi: 10.1007/s00134-021-06373-7.
    1. Tung-Chen Y. Lung ultrasound in the monitoring of COVID-19 infection. Clin Med. 2020;20:e62–e65. doi: 10.7861/clinmed.2020-0123.
    1. Vetrugno L, Baciarello M, Bignami E, et al. The “pandemic” increase in lung ultrasound use in response to Covid-19: can we complement computed tomography findings? A narrative review Ultrasound J. 2020;12:39. doi: 10.1186/s13089-020-00185-4.
    1. Convissar DL, Gibson LE, Berra L, et al. Application of lung ultrasound during the COVID-19 pandemic: a narrative review. Anesth Analg. 2020;131:345–350. doi: 10.1213/ANE.0000000000004929.
    1. Zheng Z, Peng F, Xu B, et al. Risk factors of critical & mortal COVID-19 cases: a systematic literature review and meta-analysis. J Infect. 2020;81:e16–e25. doi: 10.1016/j.jinf.2020.04.021.
    1. Korakas E, Ikonomidis I, Kousathana F, et al. Obesity and COVID-19: immune and metabolic derangement as a possible link to adverse clinical outcomes. Am J Physiol Endocrinol Metab. 2020;319:E105–E109. doi: 10.1152/ajpendo.00198.2020.
    1. Vetrugno L, Bove T, Orso D, et al. Our Italian experience using lung ultrasound for identification, grading and serial follow-up of severity of lung involvement for management of patients with COVID-19. Echocardiography. 2020;37:625–627. doi: 10.1111/echo.14664.
    1. Lichter Y, Topilsky Y, Taieb P, et al. Lung ultrasound predicts clinical course and outcomes in COVID-19 patients. Intensive Care Med. 2020;46:1873–1883. doi: 10.1007/s00134-020-06212-1.
    1. Manivel V, Lesnewski A, Shamim S, et al. CLUE: COVID-19 lung ultrasound in emergency department. Emerg Med Australas. 2020;32:694–696. doi: 10.1111/1742-6723.13546.
    1. Istvan-Adorjan S, Ágoston G, Varga A, et al. Pathophysiological background and clinical practice of lung ultrasound in COVID-19 patients: a short review. Anatol J Cardiol. 2020;24:76–80. doi: 10.14744/AnatolJCardiol.2020.33645.
    1. Jin YH, Cai L, Cheng ZS, et al. A rapid advice guideline for the diagnosis and treatment of 2019 novel coronavirus (2019-nCoV) infected pneumonia (standard version) Mil Med Res. 2020;7:4. doi: 10.1186/s40779-020-0233-6.
    1. Brahier T, Meuwly J-Y, Pantet O, et al. Lung ultrasonography for risk stratification in patients with COVID-19: a prospective observational cohort study. Clin Infect Dis. 2020 doi: 10.1093/cid/ciaa1408.
    1. Bonadia N, Carnicelli A, Piano A, et al. Lung ultrasound findings are associated with mortality and need for intensive care admission in COVID-19 patients evaluated in the emergency department. Ultrasound Med Biol. 2020;46:2927–2937. doi: 10.1016/j.ultrasmedbio.2020.07.005.
    1. Volpicelli G, Gargani L. Sonographic signs and patterns of COVID-19 pneumonia. Ultrasound J. 2020;12:22. doi: 10.1186/s13089-020-00171-w.
    1. Serafino MD, Notaro M, Rea G, et al. The lung ultrasound: facts or artifacts? In the era of COVID-19 outbreak. Radiol Med. 2020;125:738–753. doi: 10.1007/s11547-020-01236-5.

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