Abstract
PurposeTo evaluate whether there is a change in findings of coronavirus disease 2019 patients in follow up lung ultrasound and to determine whether these findings can predict the development of severe disease.Materials and methodsIn this prospective monocentric study COVID-19 patients had standardized lung ultrasound (12 area evaluation) at day 1, 3 and 5. The primary end point was detection of pathologies and their change over time. The secondary end point was relationship between change in sonographic results and clinical outcome. Clinical outcome was assessed on development of severe disease defined as need for intensive care unit.ResultsData of 30 patients were analyzed, 26 patients with follow-up lung ultrasound. All of them showed lung pathologies with dynamic patterns. 26,7% developed severe disease tending to have an ubiquitous lung involvement in lung ultrasound. In patients with need for intensive care unit a previously developed increase in B-lines, subpleural consolidations and pleural line irregularities was more common. A statistically significant association between change in B-lines as well as change in pleural line irregularities and development of severe disease was observed (p<0,01).ConclusionThe present study demonstrates that follow up lung ultrasound can be a powerful tool to track the evolution of disease and suggests that lung ultrasound is able to indicate an impending development of severe disease in COVID-19 patients.
Highlights
Up to 1st March 2021, there have been 113,820,168 officially confirmed cases of severe acute respiratory syndrome coronavirus type 2 (SARS-CoV-2) infections with a mortality of 1,6% in Germany and 2,3% worldwide [1, 2]
Recent studies confirmed that lung ultrasound (LUS) has an accuracy similar to that of computed radiography (CT) in detecting lung abnormalities [10] and that use of LUS helped in avoiding serial chest x-rays and CT scans in COVID-19 patients [11]
The presumption that larger consolidations may suggest advanced COVID-19 pneumonia [24] is reflected in our study, where we found larger pulmonary consolidation in 50% of the patients with intensive care unit (ICU) treatment and in only 4,5% of the remaining
Summary
Up to 1st March 2021, there have been 113,820,168 officially confirmed cases of severe acute respiratory syndrome coronavirus type 2 (SARS-CoV-2) infections with a mortality of 1,6% in Germany and 2,3% worldwide [1, 2]. Coronavirus disease 2019 (COVID-19) typically presents with systemic and respiratory manifestations. About 20% of hospitalized patients develop severe disease, mostly defined as fatal outcome or need for intensive care unit (ICU) [3,4,5,6]. The SARS-CoV-2 affects its cellular entry via attachment of its virion spike protein to the angiotensin-converting enzyme 2 receptor, commonly found on alveolar cells of the lung epithelium and on several other tissues, underlining the development of alveolar damage and progressive respiratory failure [7]. Recent studies confirmed that lung ultrasound (LUS) has an accuracy similar to that of CT in detecting lung abnormalities [10] and that use of LUS helped in avoiding serial chest x-rays and CT scans in COVID-19 patients [11]
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