TY - JOUR
T1 - Residual Lung Injury in Patients Recovering From COVID-19 Critical Illness
T2 - A Prospective Longitudinal Point-of-Care Lung Ultrasound Study
AU - Alharthy, Abdulrahman
AU - Abuhamdah, Mohamed
AU - Balhamar, Abdullah
AU - Faqihi, Fahad
AU - Nasim, Nasir
AU - Ahmad, Shahzad
AU - Noor, Alfateh
AU - Tamim, Hani
AU - Alqahtani, Saleh A.
AU - Abdulaziz Al Saud, Ahad Alhassan Al Saud Bin
AU - Kutsogiannis, Demetrios J.
AU - Brindley, Peter G.
AU - Memish, Ziad A.
AU - Karakitsos, Dimitrios
AU - Blaivas, Michael
N1 - Funding Information:
The study was funded by King Saud Medical City.
Publisher Copyright:
© 2020 American Institute of Ultrasound in Medicine
PY - 2021/9
Y1 - 2021/9
N2 - Scarce data exist regarding the natural history of lung lesions detected on ultrasound in those who survive severe COVID-19 pneumonia. Objective: We performed a prospective analysis of point-of-care ultrasound (POCUS) findings in critically ill COVID-19 patients during and after hospitalization. Methods: We enrolled 171 COVID-19 intensive care unit patients. POCUS of the lungs was performed with phased array (2–4 MHz), convex (2–6 MHz) and linear (10–15 MHz) transducers, scanning 12 lung areas. Chest computed tomography angiography was performed to exclude suspected pulmonary embolism. Survivors were clinically and sonographically evaluated during a 4 month period for evidence of residual lung injury. Chest computed tomography angiography and echocardiography were used to exclude pulmonary hypertension (PH) and chest high-resolution-computed-tomography to exclude interstitial lung disease (ILD) in symptomatic survivors. Results: Cox regression analysis showed that lymphocytopenia (hazard ratio [HR]: 0.88, 95% confidence intervals [CI]: 0.68–0.96, p =.048), increased lactate (HR: 1.17, 95% CI: 0.94–1.46, p = 0.049), and D-dimers (HR: 1.21, 95% CI: 1.03–1.44, p =.03) were mortality predictors. Non-survivors had increased incidence of pulmonary abnormalities (B-lines, pleural line irregularities, and consolidations) compared to survivors (p <.05). During follow-up, POCUS with clinical and laboratory parameters integrated in the semi-quantitative Riyadh-Residual-Lung-Injury scale had sensitivity of 0.82 (95% CI: 0.76–0.89) and specificity of 0.91 (95% CI: 0.94–0.95) in predicting ILD. The prevalence of PH and ILD (non-specific-interstitial-pneumonia) was 7% and 11.8%, respectively. Conclusion: POCUS showed ability to monitor the evolution of severe COVID-19 pneumonia after hospital discharge, supporting its integration in clinical predictive models of residual lung injury.
AB - Scarce data exist regarding the natural history of lung lesions detected on ultrasound in those who survive severe COVID-19 pneumonia. Objective: We performed a prospective analysis of point-of-care ultrasound (POCUS) findings in critically ill COVID-19 patients during and after hospitalization. Methods: We enrolled 171 COVID-19 intensive care unit patients. POCUS of the lungs was performed with phased array (2–4 MHz), convex (2–6 MHz) and linear (10–15 MHz) transducers, scanning 12 lung areas. Chest computed tomography angiography was performed to exclude suspected pulmonary embolism. Survivors were clinically and sonographically evaluated during a 4 month period for evidence of residual lung injury. Chest computed tomography angiography and echocardiography were used to exclude pulmonary hypertension (PH) and chest high-resolution-computed-tomography to exclude interstitial lung disease (ILD) in symptomatic survivors. Results: Cox regression analysis showed that lymphocytopenia (hazard ratio [HR]: 0.88, 95% confidence intervals [CI]: 0.68–0.96, p =.048), increased lactate (HR: 1.17, 95% CI: 0.94–1.46, p = 0.049), and D-dimers (HR: 1.21, 95% CI: 1.03–1.44, p =.03) were mortality predictors. Non-survivors had increased incidence of pulmonary abnormalities (B-lines, pleural line irregularities, and consolidations) compared to survivors (p <.05). During follow-up, POCUS with clinical and laboratory parameters integrated in the semi-quantitative Riyadh-Residual-Lung-Injury scale had sensitivity of 0.82 (95% CI: 0.76–0.89) and specificity of 0.91 (95% CI: 0.94–0.95) in predicting ILD. The prevalence of PH and ILD (non-specific-interstitial-pneumonia) was 7% and 11.8%, respectively. Conclusion: POCUS showed ability to monitor the evolution of severe COVID-19 pneumonia after hospital discharge, supporting its integration in clinical predictive models of residual lung injury.
KW - COVID-19 pneumonia
KW - interstitial lung disease
KW - point-of-care LUS
KW - predictive models
KW - residual lung injury
KW - thromboembolic disease
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U2 - 10.1002/jum.15563
DO - 10.1002/jum.15563
M3 - Article
C2 - 33185316
AN - SCOPUS:85096715008
SN - 0278-4297
VL - 40
SP - 1823
EP - 1838
JO - Journal of Ultrasound in Medicine
JF - Journal of Ultrasound in Medicine
IS - 9
ER -