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Comment
. 2021 Aug;16(5):1317-1327.
doi: 10.1007/s11739-020-02620-9. Epub 2021 Mar 1.

Lung ultrasound presentation of COVID-19 patients: phenotypes and correlations

Gianmarco Secco  1 , Marzia Delorenzo  1 , Francesco Salinaro  1 , Caterina Zattera  1 , Bruno Barcella  1 , Flavia Resta  1 , Anna Sabena  1 , Giulia Vezzoni  1 , Marco Bonzano  1 , Federica Briganti  1 , Giovanni Cappa  1 , Francesca Zugnoni  1 , Lorenzo Demitry  1 , Francesco Mojoli  2 , Fausto Baldanti  3 , Raffaele Bruno  4 , Stefano Perlini  5 ; GERICO (Gruppo Esteso RIcerca COronarovirus) Lung US Pavia Study Group
Collaborators, Affiliations
Comment

Lung ultrasound presentation of COVID-19 patients: phenotypes and correlations

Gianmarco Secco et al. Intern Emerg Med. 2021 Aug.

Abstract

Bedside lung ultrasound (LUS) can play a role in the setting of the SarsCoV2 pneumonia pandemic. To evaluate the clinical and LUS features of COVID-19 in the ED and their potential prognostic role, a cohort of laboratory-confirmed COVID-19 patients underwent LUS upon admission in the ED. LUS score was derived from 12 fields. A prevalent LUS pattern was assigned depending on the presence of interstitial syndrome only (Interstitial Pattern), or evidence of subpleural consolidations in at least two fields (Consolidation Pattern). The endpoint was 30-day mortality. The relationship between hemogasanalysis parameters and LUS score was also evaluated. Out of 312 patients, only 36 (11.5%) did not present lung involvment, as defined by LUS score < 1. The majority of patients were admitted either in a general ward (53.8%) or in intensive care unit (9.6%), whereas 106 patients (33.9%) were discharged from the ED. In-hospital mortality was 25.3%, and 30-day survival was 67.6%. A LUS score > 13 had a 77.2% sensitivity and a 71.5% specificity (AUC 0.814; p < 0.001) in predicting mortality. LUS alterations were more frequent (64%) in the posterior lower fields. LUS score was related with P/F (R2 0.68; p < 0.0001) and P/F at FiO2 = 21% (R2 0.59; p < 0.0001). The correlation between LUS score and P/F was not influenced by the prevalent ultrasound pattern. LUS represents an effective tool in both defining diagnosis and stratifying prognosis of COVID-19 pneumonia. The correlation between LUS and hemogasanalysis parameters underscores its role in evaluating lung structure and function.

Keywords: COVID-19; Echographic phenotypes; Interstitial pneumonia; LUS score; Lung ultrasound.

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Conflict of interest statement

FM received fees for lectures from GE Healthcare, Hamilton Medical, SEDA SpA. A research agreement is active between University of Pavia and Hamilton Medical.

Figures

Fig. 1
Fig. 1
a Red arrows indicate areas of interstitial syndrome (interstitial pattern); b arrow indicates a subpleural consolidation (cosolidative pattern)
Fig. 2
Fig. 2
a Percentage distribution of both vertical artefacts and consolidations in the different lung fields; b percentage distribution of consolidation lesions in the different lung field
Fig. 3
Fig. 3
Scatterplots correlation between LUS score and a P/F, b P/F at FiO2 = 21%, c correlation between the two different type ultrasound lesions, LUS score, and P/F
Fig. 4
Fig. 4
a Kaplan–Meier curves of prevalence ultrasound pattern and 30-day survival rate. b LUS pattern and CRP
Fig. 5
Fig. 5
Role of LUS score (top), P/F (middle) and PCR (bottom) in predicting 30-day mortality, according to ROC curve analysis
See this image and copyright information in PMC

Comment in

Comment on

  • COVID-19 pneumonia: different respiratory treatments for different phenotypes?
    Gattinoni L, Chiumello D, Caironi P, Busana M, Romitti F, Brazzi L, Camporota L. Gattinoni L, et al. Intensive Care Med. 2020 Jun;46(6):1099-1102. doi: 10.1007/s00134-020-06033-2. Epub 2020 Apr 14. Intensive Care Med. 2020. PMID: 32291463 Free PMC article. No abstract available.
  • COVID-19 pneumonia: ARDS or not?
    Gattinoni L, Chiumello D, Rossi S. Gattinoni L, et al. Crit Care. 2020 Apr 16;24(1):154. doi: 10.1186/s13054-020-02880-z. Crit Care. 2020. PMID: 32299472 Free PMC article. No abstract available.

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