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. 2022:9:100451.
doi: 10.1016/j.ejro.2022.100451. Epub 2022 Nov 3.

Utility and diagnostic test properties of pulmonary and cardiovascular point of care ultra-sonography (POCUS) in COVID-19 patients admitted to critical care unit

Kedar Toraskar  1 , Ravindra R Zore  1 , Gaurav A Gupta  1 , Bhooshan Gondse  1 , Gurudas Pundpal  1 , Shirishkumar Kadam  1 , Sachin Pawaskar  1 , Maninder Singh Setia  2
Affiliations

Utility and diagnostic test properties of pulmonary and cardiovascular point of care ultra-sonography (POCUS) in COVID-19 patients admitted to critical care unit

Kedar Toraskar et al. Eur J Radiol Open. 2022.

Abstract

Background: We conducted this study to assess the diagnostic test properties of point of care ultrasonography (POCUS) of lung and cardiovascular system in prediction of mortality in COVID-19 patients.

Methods: This is a cross-sectional study of 178 Covid-19 patients; POCUS was performed within one hour of admission to the ICU. We estimated sensitivity, specificity, positive predictive value, negative predictive value for prediction of mortality.

Results: The mean (SD) age of these patients was 57.3 (12.8) years. The findings were on cardiac ultrasonography were: mild pericardial effusion (45%), chamber dilatation (15%), hypokinesia (11%), and low ejection fraction (8%). In our study, 30 patients (17%) had died. A cut-off score of > to 13 (for lung ultrasound score [LUS]) had high sensitivity for mortality (93.3%, 95% CI: 77.9-99.2%). However, low ejection fraction (92.3%, 95% CI: 86,6-96.1%), and thrombosis in either vein (96.5%, 95% CI: 92.0-98.9%) were specific for mortality. A combination of LUS > =13 or low ejection fraction or thrombosis or spontaneous echo contrast (slow flow) improved sensitivity for mortality to 96.7% (95% CI: 82.8-99.9%). The agreement between LUS of > =13 and CT score of moderate/severe was 85.7% (95% CI: 62.8-100%). The interrater agreement between these two parameters was 0.82 (95% CI: 0.68, 0.97).

Conclusions: Multi-organ POCUS is effective in diagnosis, prognosis, and management of COVID-19 patients. Rather than just lung ultrasound, clinicians should use multiorgan POCUS for early identification of severe lung involvement and thrombotic changes; it may help reduce mortality in these patients.

Keywords: COVID-19 patient; Cardiovascular system; Diagnostic test properties, mortality; Lung; Point of care ultrasonography.

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Conflict of interest statement

The authors declare that they do not have any competing interest.

Figures

Fig. 1
Fig. 1
Graph showing the common findings seen on the ultrasonography of lungs in COVID-19 patients, Mumbai, India.
Fig. 2
Fig. 2
Graph showing the severity of findings in multiple zones of the lung as seen on the ultrasonography of the lung in COVID-10 patients, India.
Fig. 3
Fig. 3
A: Image showing Sub Pleural Consolidation. Fig. 3 B: Image showing irregular pleura at Left Blue Point. Fig. 3 C: Image showing B3 Lines. Fig. 3 D: Image showing Slow Flow in Common Femoral Vein.
Fig. 4
Fig. 4
Graph showing the common findings seen on the ultrasonography of cardiovascular system in COVID-19 patients, Mumbai, India.
See this image and copyright information in PMC

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