Point-of-Care Lung Ultrasound Predicts Severe Disease and Death Due to COVID-19: A Prospective Cohort Study

Paul W. Blair, MD; Trishul Siddharthan, MD; Gigi Liu, MD; Jiawei Bai, PhD; Erja Cui, BSc; Joshua East, RPSGT; Phabiola Herrera, MD; Lalaine Anova, MS; Varun Mahadevan, BA; Jimin Hwang, MD; Shakir Hossen, MBBS; Stefanie Seo, BS; Olamide Sonuga, BS; Joshua Lawrence, BS; Jillian Peters, MD; Andrea L. Cox, MD, PhD; Yukari C. Manabe, MD; Katherine Fenstermacher, PhD; Sophia Shea, MPH; Richard E. Rothman, MD, PhD; Bhakti Hansoti, MD; Lauren Sauer, MS; Ciprian Crainiceanu, PhD; Danielle V. Clark, PhD

doi:10.1097/CCE.0000000000000732

Critical Care Explorations (Aug 2022)

Point-of-Care Lung Ultrasound Predicts Severe Disease and Death Due to COVID-19: A Prospective Cohort Study

Paul W. Blair, MD,
Trishul Siddharthan, MD,
Gigi Liu, MD,
Jiawei Bai, PhD,
Erja Cui, BSc,
Joshua East, RPSGT,
Phabiola Herrera, MD,
Lalaine Anova, MS,
Varun Mahadevan, BA,
Jimin Hwang, MD,
Shakir Hossen, MBBS,
Stefanie Seo, BS,
Olamide Sonuga, BS,
Joshua Lawrence, BS,
Jillian Peters, MD,
Andrea L. Cox, MD, PhD,
Yukari C. Manabe, MD,
Katherine Fenstermacher, PhD,
Sophia Shea, MPH,
Richard E. Rothman, MD, PhD,
Bhakti Hansoti, MD,
Lauren Sauer, MS,
Ciprian Crainiceanu, PhD,
Danielle V. Clark, PhD

Affiliations

Paul W. Blair, MD: 1 Austere environments Consortium for Enhanced Sepsis Outcomes, The Henry M. Jackson Foundation for the Advancement of Military Medicine, Bethesda, MD.
Trishul Siddharthan, MD: 3 Division of Pulmonary and Critical Care Medicine, University of Miami, Miami, FL.
Gigi Liu, MD: 5 Division of General Internal Medicine, Johns Hopkins University School of Medicine, Baltimore, MD.
Jiawei Bai, PhD: 6 Department of Biostatistics, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD.
Erja Cui, BSc: 6 Department of Biostatistics, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD.
Joshua East, RPSGT: 4 Division of Pulmonary and Critical Care Medicine, Johns Hopkins University School of Medicine, Baltimore, MD.
Phabiola Herrera, MD: 3 Division of Pulmonary and Critical Care Medicine, University of Miami, Miami, FL.
Lalaine Anova, MS: 1 Austere environments Consortium for Enhanced Sepsis Outcomes, The Henry M. Jackson Foundation for the Advancement of Military Medicine, Bethesda, MD.
Varun Mahadevan, BA: 4 Division of Pulmonary and Critical Care Medicine, Johns Hopkins University School of Medicine, Baltimore, MD.
Jimin Hwang, MD: 7 Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD.
Shakir Hossen, MBBS: 4 Division of Pulmonary and Critical Care Medicine, Johns Hopkins University School of Medicine, Baltimore, MD.
Stefanie Seo, BS: 8 Department of Emergency Medicine, Johns Hopkins University, Baltimore, MD.
Olamide Sonuga, BS: 8 Department of Emergency Medicine, Johns Hopkins University, Baltimore, MD.
Joshua Lawrence, BS: 8 Department of Emergency Medicine, Johns Hopkins University, Baltimore, MD.
Jillian Peters, MD: 5 Division of General Internal Medicine, Johns Hopkins University School of Medicine, Baltimore, MD.
Andrea L. Cox, MD, PhD: 2 Division of Infectious Diseases, Johns Hopkins University School of Medicine, Baltimore, MD.
Yukari C. Manabe, MD: 2 Division of Infectious Diseases, Johns Hopkins University School of Medicine, Baltimore, MD.
Katherine Fenstermacher, PhD: 8 Department of Emergency Medicine, Johns Hopkins University, Baltimore, MD.
Sophia Shea, MPH: 8 Department of Emergency Medicine, Johns Hopkins University, Baltimore, MD.
Richard E. Rothman, MD, PhD: 8 Department of Emergency Medicine, Johns Hopkins University, Baltimore, MD.
Bhakti Hansoti, MD: 8 Department of Emergency Medicine, Johns Hopkins University, Baltimore, MD.
Lauren Sauer, MS: 8 Department of Emergency Medicine, Johns Hopkins University, Baltimore, MD.
Ciprian Crainiceanu, PhD: 6 Department of Biostatistics, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD.
Danielle V. Clark, PhD: 1 Austere environments Consortium for Enhanced Sepsis Outcomes, The Henry M. Jackson Foundation for the Advancement of Military Medicine, Bethesda, MD.

DOI: https://doi.org/10.1097/CCE.0000000000000732
Journal volume & issue: Vol. 4, no. 8
p. e0732

Abstract

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OBJECTIVES:. The clinical utility of point-of-care lung ultrasound (LUS) among hospitalized patients with COVID-19 is unclear. DESIGN:. Prospective cohort study. SETTING:. A large tertiary care center in Maryland, between April 2020 and September 2021. PATIENTS:. Hospitalized adults (≥ 18 yr old) with positive severe acute respiratory syndrome coronavirus 2 reverse transcriptase-polymerase chain reaction 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 LUS Score (mLUSS) (ranging from 0 to 3) across lung zones was determined. The primary outcome was time to ICU-level care, defined as high-flow oxygen, noninvasive, or invasive 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 61 years and 114 participants (43.2%) were female. The median mLUSS was 1.0 (interquartile range, 0.5–1.3). Following enrollment, 27 participants (10.0%) 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 (adjusted hazard ratio [aHR], 3.61; 95% CI, 1.27–10.2) and 28-day mortality (aHR, 3.10; 95% CI, 1.29–7.50). Pleural line abnormalities were independently associated with disease progression to death (aHR, 20.93; CI, 3.33–131.30). CONCLUSIONS:. Participants with a mLUSS greater than or equal to 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.

Published in Critical Care Explorations

ISSN: 2639-8028 (Online)
Publisher: Wolters Kluwer
Country of publisher: United States
LCC subjects: Medicine: Internal medicine: Medical emergencies. Critical care. Intensive care. First aid
Website: https://journals.lww.com/ccejournal/pages/default.aspx

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