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Point-of-Care Lung Ultrasound in Adults: Image Acquisition
Published on: March 3, 2023
Lung ultrasound predicts clinical course and outcomes in COVID-19 patients
Yael Lichter1, Yan Topilsky1, Philippe Taieb1
1Tel Aviv Sourasky Medical Center and Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel.
Insights
Lung ultrasound (LUS) effectively identifies COVID-19 complications. A higher LUS score predicts increased mortality and need for mechanical ventilation in hospitalized patients.
Area of Science:
- Pulmonology
- Radiology
- Infectious Diseases
Background:
- Information on lung ultrasound (LUS) for Coronavirus disease 2019 (COVID-19) is growing.
- Its role in risk stratification and outcome prediction requires further investigation.
Purpose of the Study:
- To systematically evaluate LUS findings in hospitalized COVID-19 patients.
- To correlate LUS findings with clinical course and patient outcomes.
Main Methods:
- 120 consecutive COVID-19 patients underwent LUS within 24 hours of admission.
- A LUS scoring system (0-36) was used, with higher scores indicating worse outcomes.
- LUS findings were compared with clinical data and patient outcomes.
Main Results:
- The median baseline LUS score was 15. Pleural thickening and subpleural consolidations were common.
- Higher baseline LUS scores correlated with disease severity and increased mortality.
- Clinical deterioration was associated with increased follow-up LUS scores.
Conclusions:
- Hospitalized COVID-19 patients exhibit pathological LUS findings.
- Baseline LUS score is a strong predictor of mortality and need for mechanical ventilation.
- Routine LUS can guide patient management and resource allocation.
Purpose:
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.
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