Lung Ultrasound Findings Associated With COVID-19 ARDS, ICU Admission, and All-Cause Mortality

Caroline Espersen; Elke Platz; Kristoffer Grundtvig Skaarup; Mats Christian Højbjerg Lassen; Jannie Nørgaard Lind; Niklas Dyrby Johansen; Morten Sengeløv; Alia Saed Alhakak; Anne Bjerg Nielsen; Henning Bundgaard; Christian Hassager; Reza Jabbari; Jørn Carlsen; Ole Kirk; Matias Greve Lindholm; Ole Peter Kristiansen; Olav Wendelboe Nielsen; Klaus Nielsen Jeschke; Charlotte Suppli Ulrik; Pradeesh Sivapalan; Gunnar Gislason; Kasper Iversen; Jens Ulrik Stæhr Jensen; Morten Schou; Søren Helbo Skaarup; Tor Biering-Sørensen

doi:10.4187/respcare.09108

Lung Ultrasound Findings Associated With COVID-19 ARDS, ICU Admission, and All-Cause Mortality

Caroline Espersen, Elke Platz, Kristoffer Grundtvig Skaarup, Mats Christian Højbjerg Lassen, Jannie Nørgaard Lind, Niklas Dyrby Johansen, Morten Sengeløv, Alia Saed Alhakak, Anne Bjerg Nielsen, Henning Bundgaard, Christian Hassager, Reza Jabbari, Jørn Carlsen, Ole Kirk, Matias Greve Lindholm, Ole Peter Kristiansen, Olav Wendelboe Nielsen, Klaus Nielsen Jeschke, Charlotte Suppli Ulrik, Pradeesh SivapalanGunnar Gislason, Kasper Iversen, Jens Ulrik Stæhr Jensen, Morten Schou, Søren Helbo Skaarup, Tor Biering-Sørensen

4 Citations (Scopus)

Abstract

BACKGROUND: As lung ultrasound (LUS) has emerged as a diagnostic tool in patients with COVID-19, we sought to investigate the association between LUS findings and the composite in-hospital outcome of ARDS incidence, ICU admission, and all-cause mortality.

METHODS: In this prospective, multi-center, observational study, adults with laboratory-confirmed SARS-CoV-2 infection were enrolled from non-ICU in-patient units. Subjects underwent an LUS evaluating a total of 8 zones. Images were analyzed off-line, blinded to clinical variables and outcomes. A LUS score was developed to integrate LUS findings: ≥ 3 B-lines corresponded to a score of 1, confluent B-lines to a score of 2, and subpleural or lobar consolidation to a score of 3. The total LUS score ranged from 0-24 per subject.

RESULTS: Among 215 enrolled subjects, 168 with LUS data and no current signs of ARDS or ICU admission (mean age 59 y, 56% male) were included. One hundred thirty-six (81%) subjects had pathologic LUS findings in ≥ 1 zone (≥ 3 B-lines, confluent B-lines, or consolidations). Markers of disease severity at baseline were higher in subjects with the composite outcome (n = 31, 18%), including higher median C-reactive protein (90 mg/L vs 55, P < .001) and procalcitonin levels (0.35 μg/L vs 0.13, P = .033) and higher supplemental oxygen requirements (median 4 L/min vs 2, P = .001). However, LUS findings and score did not differ significantly between subjects with the composite outcome and those without, and were not associated with outcomes in unadjusted and adjusted logistic regression analyses.

CONCLUSIONS: Pathologic findings on LUS were common a median of 3 d after admission in this cohort of non-ICU hospitalized subjects with COVID-19 and did not differ among subjects who experienced the composite outcome of incident ARDS, ICU admission, and all-cause mortality compared to subjects who did not. These findings should be confirmed in future investigations. The study is registered at Clinicaltrials.gov (NCT04377035).

Original language	English
Article number	09108
Journal	Respiratory Care
Volume	67
Issue number	1
Pages (from-to)	66-75
Number of pages	10
ISSN	0020-1324
DOIs	https://doi.org/10.4187/respcare.09108
Publication status	Published - 1 Jan 2022

Keywords

COVID-19
in-hospital outcomes
lung ultrasound
risk stratification
In-hospital outcomes
Lung ultrasound
Risk stratifi-cation

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10.4187/respcare.09108

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Espersen, C., Platz, E., Skaarup, K. G., Lassen, M. C. H., Lind, J. N., Johansen, N. D., Sengeløv, M., Alhakak, A. S., Nielsen, A. B., Bundgaard, H., Hassager, C., Jabbari, R., Carlsen, J., Kirk, O., Lindholm, M. G., Kristiansen, O. P., Nielsen, O. W., Jeschke, K. N., Ulrik, C. S., ... Biering-Sørensen, T. (2022). Lung Ultrasound Findings Associated With COVID-19 ARDS, ICU Admission, and All-Cause Mortality. Respiratory Care, 67(1), 66-75. Article 09108. https://doi.org/10.4187/respcare.09108

Espersen, C, Platz, E, Skaarup, KG, Lassen, MCH, Lind, JN, Johansen, ND , Sengeløv, M , Alhakak, AS , Nielsen, AB , Bundgaard, H , Hassager, C , Jabbari, R , Carlsen, J , Kirk, O, Lindholm, MG, Kristiansen, OP , Nielsen, OW , Jeschke, KN , Ulrik, CS , Sivapalan, P , Gislason, G , Iversen, K , Jensen, JUS , Schou, M, Skaarup, SH & Biering-Sørensen, T 2022, 'Lung Ultrasound Findings Associated With COVID-19 ARDS, ICU Admission, and All-Cause Mortality', Respiratory Care, vol. 67, no. 1, 09108, pp. 66-75. https://doi.org/10.4187/respcare.09108

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title = "Lung Ultrasound Findings Associated With COVID-19 ARDS, ICU Admission, and All-Cause Mortality",

abstract = "BACKGROUND: As lung ultrasound (LUS) has emerged as a diagnostic tool in patients with COVID-19, we sought to investigate the association between LUS findings and the composite in-hospital outcome of ARDS incidence, ICU admission, and all-cause mortality.METHODS: In this prospective, multi-center, observational study, adults with laboratory-confirmed SARS-CoV-2 infection were enrolled from non-ICU in-patient units. Subjects underwent an LUS evaluating a total of 8 zones. Images were analyzed off-line, blinded to clinical variables and outcomes. A LUS score was developed to integrate LUS findings: ≥ 3 B-lines corresponded to a score of 1, confluent B-lines to a score of 2, and subpleural or lobar consolidation to a score of 3. The total LUS score ranged from 0-24 per subject.RESULTS: Among 215 enrolled subjects, 168 with LUS data and no current signs of ARDS or ICU admission (mean age 59 y, 56% male) were included. One hundred thirty-six (81%) subjects had pathologic LUS findings in ≥ 1 zone (≥ 3 B-lines, confluent B-lines, or consolidations). Markers of disease severity at baseline were higher in subjects with the composite outcome (n = 31, 18%), including higher median C-reactive protein (90 mg/L vs 55, P < .001) and procalcitonin levels (0.35 μg/L vs 0.13, P = .033) and higher supplemental oxygen requirements (median 4 L/min vs 2, P = .001). However, LUS findings and score did not differ significantly between subjects with the composite outcome and those without, and were not associated with outcomes in unadjusted and adjusted logistic regression analyses.CONCLUSIONS: Pathologic findings on LUS were common a median of 3 d after admission in this cohort of non-ICU hospitalized subjects with COVID-19 and did not differ among subjects who experienced the composite outcome of incident ARDS, ICU admission, and all-cause mortality compared to subjects who did not. These findings should be confirmed in future investigations. The study is registered at Clinicaltrials.gov (NCT04377035).",

keywords = "COVID-19, in-hospital outcomes, lung ultrasound, risk stratification, In-hospital outcomes, Lung ultrasound, Risk stratifi-cation",

author = "Caroline Espersen and Elke Platz and Skaarup, {Kristoffer Grundtvig} and Lassen, {Mats Christian H{\o}jbjerg} and Lind, {Jannie N{\o}rgaard} and Johansen, {Niklas Dyrby} and Morten Sengel{\o}v and Alhakak, {Alia Saed} and Nielsen, {Anne Bjerg} and Henning Bundgaard and Christian Hassager and Reza Jabbari and J{\o}rn Carlsen and Ole Kirk and Lindholm, {Matias Greve} and Kristiansen, {Ole Peter} and Nielsen, {Olav Wendelboe} and Jeschke, {Klaus Nielsen} and Ulrik, {Charlotte Suppli} and Pradeesh Sivapalan and Gunnar Gislason and Kasper Iversen and Jensen, {Jens Ulrik St{\ae}hr} and Morten Schou and Skaarup, {S{\o}ren Helbo} and Tor Biering-S{\o}rensen",

note = "Copyright {\textcopyright} 2021 by Daedalus Enterprises.",

year = "2022",

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doi = "10.4187/respcare.09108",

language = "English",

volume = "67",

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journal = "Respiratory Care",

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TY - JOUR

T1 - Lung Ultrasound Findings Associated With COVID-19 ARDS, ICU Admission, and All-Cause Mortality

AU - Espersen, Caroline

AU - Platz, Elke

AU - Skaarup, Kristoffer Grundtvig

AU - Lassen, Mats Christian Højbjerg

AU - Lind, Jannie Nørgaard

AU - Johansen, Niklas Dyrby

AU - Sengeløv, Morten

AU - Alhakak, Alia Saed

AU - Nielsen, Anne Bjerg

AU - Bundgaard, Henning

AU - Hassager, Christian

AU - Jabbari, Reza

AU - Carlsen, Jørn

AU - Kirk, Ole

AU - Lindholm, Matias Greve

AU - Kristiansen, Ole Peter

AU - Nielsen, Olav Wendelboe

AU - Jeschke, Klaus Nielsen

AU - Ulrik, Charlotte Suppli

AU - Sivapalan, Pradeesh

AU - Gislason, Gunnar

AU - Iversen, Kasper

AU - Jensen, Jens Ulrik Stæhr

AU - Schou, Morten

AU - Skaarup, Søren Helbo

AU - Biering-Sørensen, Tor

PY - 2022/1/1

Y1 - 2022/1/1

N2 - BACKGROUND: As lung ultrasound (LUS) has emerged as a diagnostic tool in patients with COVID-19, we sought to investigate the association between LUS findings and the composite in-hospital outcome of ARDS incidence, ICU admission, and all-cause mortality.METHODS: In this prospective, multi-center, observational study, adults with laboratory-confirmed SARS-CoV-2 infection were enrolled from non-ICU in-patient units. Subjects underwent an LUS evaluating a total of 8 zones. Images were analyzed off-line, blinded to clinical variables and outcomes. A LUS score was developed to integrate LUS findings: ≥ 3 B-lines corresponded to a score of 1, confluent B-lines to a score of 2, and subpleural or lobar consolidation to a score of 3. The total LUS score ranged from 0-24 per subject.RESULTS: Among 215 enrolled subjects, 168 with LUS data and no current signs of ARDS or ICU admission (mean age 59 y, 56% male) were included. One hundred thirty-six (81%) subjects had pathologic LUS findings in ≥ 1 zone (≥ 3 B-lines, confluent B-lines, or consolidations). Markers of disease severity at baseline were higher in subjects with the composite outcome (n = 31, 18%), including higher median C-reactive protein (90 mg/L vs 55, P < .001) and procalcitonin levels (0.35 μg/L vs 0.13, P = .033) and higher supplemental oxygen requirements (median 4 L/min vs 2, P = .001). However, LUS findings and score did not differ significantly between subjects with the composite outcome and those without, and were not associated with outcomes in unadjusted and adjusted logistic regression analyses.CONCLUSIONS: Pathologic findings on LUS were common a median of 3 d after admission in this cohort of non-ICU hospitalized subjects with COVID-19 and did not differ among subjects who experienced the composite outcome of incident ARDS, ICU admission, and all-cause mortality compared to subjects who did not. These findings should be confirmed in future investigations. The study is registered at Clinicaltrials.gov (NCT04377035).

AB - BACKGROUND: As lung ultrasound (LUS) has emerged as a diagnostic tool in patients with COVID-19, we sought to investigate the association between LUS findings and the composite in-hospital outcome of ARDS incidence, ICU admission, and all-cause mortality.METHODS: In this prospective, multi-center, observational study, adults with laboratory-confirmed SARS-CoV-2 infection were enrolled from non-ICU in-patient units. Subjects underwent an LUS evaluating a total of 8 zones. Images were analyzed off-line, blinded to clinical variables and outcomes. A LUS score was developed to integrate LUS findings: ≥ 3 B-lines corresponded to a score of 1, confluent B-lines to a score of 2, and subpleural or lobar consolidation to a score of 3. The total LUS score ranged from 0-24 per subject.RESULTS: Among 215 enrolled subjects, 168 with LUS data and no current signs of ARDS or ICU admission (mean age 59 y, 56% male) were included. One hundred thirty-six (81%) subjects had pathologic LUS findings in ≥ 1 zone (≥ 3 B-lines, confluent B-lines, or consolidations). Markers of disease severity at baseline were higher in subjects with the composite outcome (n = 31, 18%), including higher median C-reactive protein (90 mg/L vs 55, P < .001) and procalcitonin levels (0.35 μg/L vs 0.13, P = .033) and higher supplemental oxygen requirements (median 4 L/min vs 2, P = .001). However, LUS findings and score did not differ significantly between subjects with the composite outcome and those without, and were not associated with outcomes in unadjusted and adjusted logistic regression analyses.CONCLUSIONS: Pathologic findings on LUS were common a median of 3 d after admission in this cohort of non-ICU hospitalized subjects with COVID-19 and did not differ among subjects who experienced the composite outcome of incident ARDS, ICU admission, and all-cause mortality compared to subjects who did not. These findings should be confirmed in future investigations. The study is registered at Clinicaltrials.gov (NCT04377035).

KW - COVID-19

KW - in-hospital outcomes

KW - lung ultrasound

KW - risk stratification

KW - In-hospital outcomes

KW - Lung ultrasound

KW - Risk stratifi-cation

UR - http://www.scopus.com/inward/record.url?scp=85125626508&partnerID=8YFLogxK

U2 - 10.4187/respcare.09108

DO - 10.4187/respcare.09108

M3 - Journal article

C2 - 34815326

SN - 0020-1324

VL - 67

SP - 66

EP - 75

JO - Respiratory Care

JF - Respiratory Care

IS - 1

M1 - 09108

ER -

Lung Ultrasound Findings Associated With COVID-19 ARDS, ICU Admission, and All-Cause Mortality

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