Key Results 1. A model using baseline patient characteristics, laboratory markers, and chest radiography can predict short-term critical illness in hospitalized patients with COVID-19, with an internally validated AUC = 0.77. 2. At an example model risk threshold of 0.70, 71 of 356 patients would be predicted to develop critical illness of which 59 (83%) would be true-positives. 3. A risk calculator has been made available for download: Dutch COVID-19 risk model (https://docs.google.com/spreadsheets/d/1eFrdHxnOA-M_P-ijxnC2u30qk7IhMVV6YvHvJhrZ8Ws/edit#gid=0) (see Appendix E2).

IntroductionSurvivors of COVID-19 frequently endure chronic disabilities. We hypothesize that diaphragm function has a long recovery time after COVID-19 hospitalization, and may play a role in post-COVID syndrome. The aim of this study was to assess diaphragm function during COVID-19 hospitalization and during recovery.MethodsWe conducted a prospective single-center cohort study in 49 patients enrolled, of which 28 completed one-year follow-up. Participants were evaluated for diaphragm function. Diaphragm function was assessed using ultrasound measuring of diaphragm thickening fraction (TF) within 24 h after admission, after 7 days of admission or at discharge, whichever came first, and three and twelve months after hospital admission.ResultsEstimated mean TF increased from 0.56 (95% CI 0.46–0.66) on admission to 0.78 (95% CI 0.65–0.89) at discharge or seven days after admission, to 1.05 (95% CI 0.83–1.26) three months after admission to 1.54 (95% CI 1.31–1.76) twelve months after admission. The improvements from admission to discharge, 3 months and 12 months were all significant (linear mixed modeling; p=0.020, p<0.001, and p<0.001, respectively) and the improvement from discharge to three months follow-up was borderline significant (p<0.1).ConclusionDiaphragm function was impaired during hospitalization for COVID-19. During recovery in hospital and up to one-year follow-up, diaphragm TF improved, suggesting a long recovery time of the diaphragm. Diaphragm ultrasound may be a valuable modality in the screening and follow-up of (post-)COVID-19 patients for diaphragm dysfunction.

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The aim of this study is to evaluate feasibility of monitoring the process of pleurodesis after surgical pleurectomy with thoracic ultrasound. Repetitive measurements with thoracic ultrasound after surgical pleurectomy could provide information on the extent and development speed of pleurodesis. We conducted a prospective single-center cohort study. Adult patients who required surgical pleurectomy after pneumothorax were eligible. Participants had daily thoracic ultrasound examination until discharge to determine lung sliding [present (0 point), questionable (1 point), or absent (2 points)], and pleural thickening [normal (0 point), questionable (1 point), or present (2 points)]. Thoracic ultrasound was performed in six regions, the sum of all scores was divided by the number of regions. Fourteen patients were enrolled. Thoracic ultrasound on day 1–4 was 0.25±0.26, 0.39±0.48, 0.84±0.49, 1.12±0.56 for mean lung sliding, and 1.0±0.56, 1.17±0.48, 1.44±0.44, 1.54±0.34 for mean pleural thickening. Lung sliding and pleural thickening increased significantly between day 1 and day 4 (P=0.002 and P=0.023, respectively). One (7%) and 3 (21%) patients reached the maximum achievable grade for lung sliding and pleural thickening, respectively. Thoracic ultrasound grades tended to be lower in three patients with recurrent pneumothorax, although this was not statistically significant. This study shows a significant increase in thoracic ultrasound grading for pleurodesis lung sliding and pleural thickening during the first postoperative days after surgical pleurectomy, probably attributable to progressing pleurodesis. Only a minority of patients reached complete pleurodesis before discharge despite complete surgical pleurodesis (SP). The results of this study may guide future research regarding optimal timing of chest tube removal.