Point-of-care lung ultrasound predicts severe disease and death due to COVID-19: a prospective cohort study

  1. Paul W. Blair
  2. Trishul Siddharthan
  3. Gigi Liu
  4. Jiawei Bai
  5. Joshua East
  6. Phabiola Herrera
  7. Lalaine Anova
  8. Varun Mahadevan
  9. Shakir Hossen
  10. Stefanie Seo
  11. Olamide Sonuga
  12. Joshua Lawrence
  13. Jillian Peters
  14. Andrea Cox
  15. Yukari C. Manabe
  16. Katherine Fenstermacher
  17. Sophia Shea
  18. Richard E. Rothman
  19. Bhakti Hansoti
  20. Lauren Sauer
  21. Ciprian Crainiceanu
  22. Danielle V. Clark
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Abstract

Objective

The clinical utility of point-of-care lung ultrasound (LUS) for disease severity triage of hospitalized patients with COVID-19 is unclear.

Design

Prospective cohort study

Setting

A large tertiary care center in Maryland, USA between April 2020 to September 2021.

Patients

Hospitalized adults (≥18 years of age) with positive SARS-CoV-2 RT-PCR 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 Lung Ultrasound Score (ranging from 0 to 3) across lung zones (mLUSS) was determined. The primary outcome was time to ICU-level care, defined as high flow oxygen, noninvasive, or 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 59 years and 114 (43.2) % of participants were female. The median mLUSS was 1 (interquartile range: 0.5 to 1.3). Following enrollment, 29 (11.0%) participants 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 (aHR = 3.63; 95% CI: 1.23 to 10.65) and 28-day mortality (aHR = 4.50; 95% CI: 1.52 to 13.31). Pleural line abnormalities were independently associated with disease progression to ICU-level care (aHR = 18.86; CI: 1.57 to 226.09).

Conclusions

Participants with a mLUSS ≥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.

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