Pulmonary Findings in Hospitalized COVID-19 Patients Assessed by Lung Ultrasonography (LUS) – A Prospective Registry Study

 

 Buy Article Permissions and Reprints

Abstract

Purpose This prospective two-centre study investigated localisation-dependent lesion patterns in COVID-19 with standard lung ultrasonography (LUS) and their relationship with thoracic computed tomography (CT) and clinical parameters.

Materials and Methods Between April 2020 and April 2021, 52 SARS-CoV-2-positive patients in two hospitals were examined by means of LUS for “B-lines”, fragmented pleura, consolidation and air bronchogram in 12 lung regions and for pleural effusions. A newly developed LUS score based on the number of features present was correlated with clinical parameters (respiration, laboratory parameters) and the CT and analysed with respect to the 30- and 60-day outcome. All patients were offered an outpatient LUS follow-up.

Results The LUS and CT showed a bilateral, partially posteriorly accentuated lesion distribution pattern. 294/323 (91%) of CT-detected lesions were pleural. The LUS score showed an association with respiratory status and C-reactive protein; the correlation with the CT score was weak (Spearman’s rho = 0.339, p < 0.001). High LUS scores on admission were also observed in patients who were discharged within 30 days. LUS during follow-up showed predominantly declining LUS scores.

Conclusion The LUS score reflected the clinical condition of the patients. No conclusion could be made on the prognostic value of the LUS, because of the low event rate. The LUS and CT score showed no sufficient correlation. This is probably due to different physical principles, which is why LUS could be of complementary value.

Zusammenfassung

Ziel Die prospektive Zwei-Center-Studie untersuchte lokalisationsabhängige Läsionsmuster bei COVID-19 mit standardisierter Lungensonografie (LUS) und ihren Zusammenhang mit der Thorax-Computertomografie (CT) und klinischen Parametern.

Material und Methode Zwischen April 2020 und April 2021 wurden 52 SARS-CoV-2-positive Patientinnen und Patienten in 2 Krankenhäusern mittels LUS in 12 Lungenregionen auf „B-Linien“, fragmentierte Pleura, Konsolidierung und Aerobronchogramm sowie auf Pleuraergüsse untersucht. Ein neuer LUS-Score, basierend auf der Anzahl der vorhandenen Merkmale, wurde mit klinischen Parametern (Atmung, Laborparametern) und der CT korreliert und bezüglich des 30- und 60-Tage-Outcomes analysiert. Allen Patienten wurde eine LUS-Verlaufskontrolle angeboten.

Ergebnisse LUS und CT zeigten ein bilaterales, teils posterior betontes Läsionsmuster. 294/323 (91%) der CT-detektierten Läsionen waren pleuraständig. Der LUS-Score zeigte einen Zusammenhang mit dem respiratorischen Status und dem C-reaktiven Protein; die Korrelation mit dem CT-Score war schwach (Spearmans Rho = 0,339, p < 0,001). Auch bei innerhalb von 30 Tagen entlassenen Patienten konnten hohe LUS-Scores bei Aufnahme beobachtet werden. Bei LUS im Verlauf zeigten sich überwiegend rückläufige LUS-Scores.

Schlussfolgerungen Der LUS-Score spiegelte den klinischen Zustand der Patienten wider. Über den prognostischen Wert der LUS konnte aufgrund der geringen Ereignisrate keine Aussage getroffen werden. LUS- und CT-Score zeigten keine ausreichende Korrelation. Dies ist wahrscheinlich auf unterschiedliche physikalische Prinzipien zurückzuführen, weshalb die LUS komplementär wertvoll sein könnte.

Publication History

Received: 11 September 2022

Accepted after revision: 16 January 2023

Accepted Manuscript online:
16 January 2023

Article published online:
20 March 2023

© 2023. Thieme. All rights reserved.

Georg Thieme Verlag KG
Rüdigerstraße 14, 70469 Stuttgart, Germany

• References

• 1 Huang C, Wang Y, Li X. et al. Clinical features of patients infected with 2019 novel coronavirus in Wuhan, China. Lancet 2020; 395: 497-506 DOI: 10.1016/s0140-6736(20)30183-5.
  CrossrefPubMedGoogle Scholar
• 2 Lo Giudice V, Bruni A, Corcioni E. et al. Ultrasound in the evaluation of interstitial pneumonia. J Ultrasound 2008; 11: 30-38 DOI: 10.1016/j.jus.2007.10.002. (PMID: 23396220)
  CrossrefPubMedGoogle Scholar
• 3 Chavez MA, Shams N, Ellington LE. et al. Lung ultrasound for the diagnosis of pneumonia in adults: a systematic review and meta-analysis. Respir Res 2014; 15: 50 DOI: 10.1186/1465-9921-15-50. (PMID: 24758612)
  CrossrefPubMedGoogle Scholar
• 4 Long L, Zhao HT, Zhang ZY. et al. Lung ultrasound for the diagnosis of pneumonia in adults: A meta-analysis. Medicine (Baltimore) 2017; 96: e5713 DOI: 10.1097/md.0000000000005713. (PMID: 28099332)
  CrossrefPubMedGoogle Scholar
• 5 Zheng Y, Wang L, Ben S. Meta-analysis of chest CT features of patients with COVID-19 pneumonia. J Med Virol 2021; 93: 241-249 DOI: 10.1002/jmv.26218. (PMID: 32579236)
  CrossrefPubMedGoogle Scholar
• 6 Peng QY, Wang XT, Zhang LN. et al. Findings of lung ultrasonography of novel corona virus pneumonia during the 2019–2020 epidemic. Intensive Care Med 2020; 46: 849-850 DOI: 10.1007/s00134-020-05996-6.
  CrossrefPubMedGoogle Scholar
• 7 Buonsenso D, Piano A, Raffaelli F. et al. Point-of-Care Lung Ultrasound findings in novel coronavirus disease-19 pnemoniae: a case report and potential applications during COVID-19 outbreak. Eur Rev Med Pharmacol Sci 2020; 24: 2776-2780 DOI: 10.26355/eurrev_202003_20549.
  CrossrefPubMedGoogle Scholar
• 8 Schmid M, Escher F, Clevert DA. Lung ultrasonography in COVID-19 pneumonia. Radiologe 2020; 60: 919-926 DOI: 10.1007/s00117-020-00747-6. (PMID: 32909049)
  CrossrefPubMedGoogle Scholar
• 9 Osterwalder J. COVID-19 – More Lung Pocus and Sparing Use of Stethoscope, Chest X-Ray and Lung CT. Praxis (Bern 1994) 2020; 109: 583-591 DOI: 10.1024/1661-8157/a003512. (PMID: 32356672)
  CrossrefPubMedGoogle Scholar
• 10 Colombi D, Petrini M, Maffi G. et al. Comparison of admission chest computed tomography and lung ultrasound performance for diagnosis of COVID-19 pneumonia in populations with different disease prevalence. Eur J Radiol 2020; 133: 109344 DOI: 10.1016/j.ejrad.2020.109344.
  CrossrefPubMedGoogle Scholar
• 11 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 2021; 40: 1391-1399 DOI: 10.1002/jum.15521.
  CrossrefPubMedGoogle Scholar
• 12 Tana C, Ricci F, Coppola MG. et al. Prognostic Significance of Chest Imaging by LUS and CT in COVID-19 Inpatients: The ECOVID Multicenter Study. Respiration 2022; 101: 122-131 DOI: 10.1159/000518516. (PMID: 34515247)
  CrossrefPubMedGoogle Scholar
• 13 Tombini V, Di Capua M, Capsoni N. et al. Risk Stratification in COVID-19 Pneumonia – Determining the Role of Lung Ultrasound. Ultraschall in Med 2022; 43: 168-176 DOI: 10.1055/a-1344-4715. (PMID: 33601427)
  Article in Thieme ConnectPubMedGoogle Scholar
• 14 DEGUM. Accessed September 04, 2022 at: https://www.degum.de/fileadmin/dokumente/service/Downloads/Poster_A4-Lungenultraschall-Protokoll_DEGUM_SGUM_OEGM_V3_06042020_Print_digital_NEU.pdf
  PubMed
• 15 Smilowitz NR, Kunichoff D, Garshick M. et al. C-reactive protein and clinical outcomes in patients with COVID-19. Eur Heart J 2021; 42: 2270-2279 DOI: 10.1093/eurheartj/ehaa1103.
  CrossrefPubMedGoogle Scholar
• 16 Alharthy A, Abuhamdah M, Balhamar A. et al. Residual Lung Injury in Patients Recovering From COVID-19 Critical Illness: A Prospective Longitudinal Point-of-Care Lung Ultrasound Study. J Ultrasound Med 2021; 40: 1823-1838 DOI: 10.1002/jum.15563.
  CrossrefPubMedGoogle Scholar
• 17 Kunze G, Kovacikova E, Haller H. et al. Lung ultrasound in patients with SARS-CoV-2 infection. Notf Rett Med 2020; 23: 529-537 DOI: 10.1007/s10049-020-00767-8.
  CrossrefPubMedGoogle Scholar
• 18 Yang Y, Huang Y, Gao F. et al. Lung ultrasonography versus chest CT in COVID-19 pneumonia: a two-centered retrospective comparison study from China. Intensive Care Med 2020; 46: 1761-1763 DOI: 10.1007/s00134-020-06096-1.
  CrossrefPubMedGoogle Scholar
• 19 European Society of Radiology (ESR). The role of lung ultrasound in COVID-19 disease. Insights Imaging 2021; 12: 81 DOI: 10.1186/s13244-021-01013-6.
  CrossrefPubMedGoogle Scholar
• 20 Volpicelli G, Gargani L. Sonographic signs and patterns of COVID-19 pneumonia. Ultrasound J 2020; 12: 22 DOI: 10.1186/s13089-020-00171-w. (PMID: 32318891)
  CrossrefPubMedGoogle Scholar
• 21 Bennett D, De Vita E, Mezzasalma F. et al. Portable Pocket-Sized Ultrasound Scanner for the Evaluation of Lung Involvement in Coronavirus Disease 2019 Patients. Ultrasound Med Biol 2021; 47: 19-24 DOI: 10.1016/j.ultrasmedbio.2020.09.014. (PMID: 33082053)
  CrossrefPubMedGoogle Scholar
• 22 Nielsen MB, Cantisani V, Sidhu PS. et al. The Use of Handheld Ultrasound Devices – An EFSUMB Position Paper. Ultraschall in Med 2019; 40: 30-39 DOI: 10.1055/a-0783-2303. (PMID: 30577046)
  Article in Thieme ConnectPubMedGoogle Scholar
• 23 Beckh S. Indications, Technical Prerequisites, and Investigation Procedure. In: Mathis G, Lessnau KD. Atlas of Chest Sonography Springer. 2003: 1-6 DOI: 10.1007/978-3-662-05278-5
  CrossrefGoogle Scholar
• 24 Rizzetto F, Perillo N, Artioli D. et al. Correlation between lung ultrasound and chest CT patterns with estimation of pulmonary burden in COVID-19 patients. Eur J Radiol 2021; 138: 109650 DOI: 10.1016/j.ejrad.2021.109650.
  CrossrefPubMedGoogle Scholar
• 25 Castelao J, Graziani D, Soriano JB. et al. Findings and Prognostic Value of Lung Ultrasound in COVID-19 Pneumonia. J Ultrasound Med 2021; 40: 1315-1324 DOI: 10.1002/jum.15508. (PMID: 32936491)
  CrossrefPubMedGoogle Scholar
• 26 Wang L. C-reactive protein levels in the early stage of COVID-19. Med Mal Infect 2020; 50: 332-334 DOI: 10.1016/j.medmal.2020.03.007. (PMID: 32243911)
  CrossrefPubMedGoogle Scholar