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

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.

Keywords

lung ultrasonography - COVID-19 - computed tomography - pneumonia - outcome

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