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

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  • 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
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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 languageEnglish
Article number09108
JournalRespiratory Care
Volume67
Issue number1
Pages (from-to)66-75
Number of pages10
ISSN0020-1324
DOIs
Publication statusPublished - 1 Jan 2022

Bibliographical note

Copyright © 2021 by Daedalus Enterprises.

    Research areas

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

ID: 69541897