Lung ultrasound findings following COVID-19 hospitalization: A prospective longitudinal cohort study

Espersen, Caroline; Platz, Elke; Alhakak, Alia Saed; Sengeløv, Morten; Simonsen, Jakob Øystein; Johansen, Niklas Dyrby; Davidovski, Filip Soeskov; Christensen, Jens Peter; Bundgaard, Henning; Hassager, Christian; Jabbari, Reza; Carlsen, Jørn; Kirk, Ole; Lindholm, Matias Greve; Kristiansen, Ole Peter; Nielsen, Olav Wendelboe; Jeschke, Klaus Nielsen; Ulrik, Charlotte Suppli; Sivapalan, Pradeesh; Iversen, Kasper; Schou, Morten; Skaarup, Søren Helbo; Lassen, Mats Christian Højbjerg; Skaarup, Kristoffer Grundtvig

doi:10.1016/j.rmed.2022.106826

Cited by 8 publications

(5 citation statements)

References 45 publications

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“…While the meta-analysis only reported on subjective symptoms at follow-up, other studies have described ultrasonographic findings in the period after COVID-19 hospital admission. For instance, a recent study by Espersen and colleagues supports our findings that most patients experience complete TUS resolution following discharge [ 33 ]. In this study, 71 patients who had been subject to an 8-zone TUS examination of anterior and lateral zones during COVID-19-admission were re-examined at 2–3 months following discharge.…”

Section: Discussionsupporting

confidence: 79%

Thoracic ultrasonographic and clinical findings at 12-month follow-up of patients admitted with COVID-19

Falster,

Juul,

Jacobsen

et al. 2023

European Clinical Respiratory Journal

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Introduction Thoracic ultrasound (TUS) has proven useful in the diagnosis, risk stratification and monitoring of disease progression in patients with coronavirus disease 2019 (COVID-19). However, utility in follow-up is poorly described. To elucidate this area, we performed TUS as part of a 12-month clinical follow-up in patients previously admitted with COVID-19 and correlated findings with clinical assessment and pulmonary function tests. Methods Adult patients discharged from our hospital following admission with COVID-19 during March to May 2020 were invited to a 12-month follow-up. Enrolled patients were interviewed regarding persisting or newly developed symptoms in addition to TUS, spirometry and a 6-min walk test. Patients were referred to high-resolution computed tomography (HRCT) of the lungs if suspicion of pulmonary fibrosis was raised. Results Forty patients were enrolled in the study of whom had 13 developed acute respiratory distress syndrome (ARDS) during admission. Patients with ARDS were more prone to experience neurological symptoms at follow-up ( p = 0.03) and showed more B-lines on TUS ( p = 0.008) but did not otherwise differ significantly in terms of pulmonary function tests. Four patients had pathological findings on TUS where subsequent diagnostics revealed that two had interstitial lung abnormalities and two had heart failure. These four patients presented with a significantly lower diffusing capacity of lung for carbon monoxide ( p =0.03) and 6-min walking distance ( p =0.006) compared to the remaining 36 patients without ultrasound pathology. No significant difference was observed in spirometry values of % of predicted FEV1 ( p =0.49) or FVC ( p =0.07). No persisting cardiovascular pathology was observed in patients without ultrasonographic pathology. Conclusion At 12-month after admission with COVID-19, a follow-up combining TUS, clinical assessment, and pulmonary function tests may improve the selection of patients requiring further diagnostic investigations such as HRCT or echocardiography.

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Section: Discussionsupporting

confidence: 79%

Thoracic ultrasonographic and clinical findings at 12-month follow-up of patients admitted with COVID-19

Falster,

Juul,

Jacobsen

et al. 2023

European Clinical Respiratory Journal

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“…Many studies have now demonstrated that ultrasound can be a useful tool for monitoring disease progression and improvement, especially in hospitalized patients and upon follow-up. These studies show that, as expected, lung ultrasound findings improve over time [ 18 ]. A recent study also used ultrasound to monitor the evolution of severe COVID pneumonia in ICU patients after hospital discharge [ 5 ].…”

Section: Discussionsupporting

confidence: 76%

Point-of-Care Ultrasound of Post-acute COVID-19 Syndrome: A Prospective Cohort Study

Dearing¹,

Rempfer²,

Frasure³

et al. 2023

Cureus

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Introduction Acute COVID-19 patients can suffer from chronic symptoms known as post-acute sequelae of SARS-CoV-2 infection (PASC). Point-of-care ultrasound (POCUS) is established in acute COVID, but its utility in PASC is unclear. We sought to determine the incidence of cardiac and pulmonary abnormalities with POCUS in patients with PASC in a COVID-19 recovery clinic. Methods This prospective cohort study included adults (>18 years old) presenting with cardiopulmonary symptoms to the COVID-19 recovery clinic. A lung ultrasound and standard bedside echocardiogram were performed by ultrasound-trained physicians. Images were interpreted in real time by the performing sonographer and independently by a blinded ultrasound faculty member. Discrepancies in interpretation were addressed by consensus review. A modified Soldati score was calculated by the sum of the scores in each of the 12 lung zones, with each zone score ranging from 0 to 3 (maximum score of 36). The score was then compared to clinical outcomes and outpatient testing. Results Between April and July 2021, 41 patients received POCUS examinations, with 24 of those included in the study. In all, 15 out of 24 (62.5%) had a normal lung ultrasound. Of the nine subjects with lung abnormalities, the median modified Soldati score was 2. Three patients had trivial pericardial effusions, and all had normal left and right ventricular size and function. Conclusion The majority (62.5%) of patients presenting to the PASC clinic had a normal pulmonary ultrasound, and the vast majority (87.5%) had normal cardiac ultrasounds. These findings suggest that cardiopulmonary symptoms in PASC may be from etiologies not well evaluated by POCUS.

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“…A growing body of evidence indicates that some diagnostic tools, including the lung ultrasound (LUC) may present some usefulness in diagnosis, optimization of treatment, and risk stratification in COVID-19 patients [ 30 , 31 , 32 ]. Therefore, a multidimensional assessment of risk factors for an unfavorable outcome of COVID-19, including the data from imaging diagnostics, could constitute an interesting approach.…”

Section: Discussionmentioning

confidence: 99%

Usefulness of C2HEST Score in Predicting Clinical Outcomes of COVID-19 in Heart Failure and Non-Heart-Failure Cohorts

Rola¹,

Doroszko

Trocha

et al. 2022

JCM

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Background: Patients with heart failure represent a vulnerable population for COVID-19 and are prone to having worse prognoses and higher fatality rates. Still, the clinical course of the infection is dynamic, and complication occurrence in particular in patients with heart failure is fairly unpredictable. Considering that individual components of the C2HEST (C2: Coronary Artery Diseases (CAD)/Chronic obstructive pulmonary disease (COPD); H: Hypertension; E: Elderly (Age ≥ 75); S: Systolic HF; T: Thyroid disease) are parallel to COVID-19 mortality risk factors, we evaluate the predictive value of C2HEST score in patients with heart failure (HF) Material and Methods: The retrospective medical data analysis of 2184 COVID-19 patients hospitalized in the University Hospital in Wroclaw between February 2020 and June 2021 was the basis of the study. The measured outcomes included: in-hospital mortality, 3-month and 6-month all-cause-mortality, non-fatal end of hospitalization, and adverse in-hospital clinical events. Results: The heart failure cohort consists of 255 patients, while 1929 patients were assigned to the non-HF cohort. The in-hospital, 3-month, and 6-month mortality rates were highest in the HF cohort high-risk C2HEST stratum, reaching 38.61%, 53.96%, and 65.36%, respectively. In the non-HF cohort, in-hospital, 3-month, and 6-month mortalities were also highest in the high-risk C2HEST stratum and came to 26.39%, 52.78%, and 65.0%, respectively. An additional point in the C2HEST score increased the total death intensity in 10% of HF subjects (HR 1.100, 95% CI 0.968–1.250 p = 0.143) while in the non-HF cohort, the same value increased by 62.3% (HR 1.623, 95% CI 1.518–1.734 p < 0.0001). Conclusions: The C2HEST score risk in the HF cohort failed to show discriminatory performance in terms of mortality and other clinical adverse outcomes during hospitalization. C2HEST score in the non-HF cohort showed significantly better performance in terms of predicting in-hospital and 6-month mortality and other non-fatal clinical outcomes such as cardiovascular events (myocardial injury, acute heart failure, myocardial infarction, cardiogenic shock), pneumonia, sepsis, and acute renal injury.

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Lung ultrasound findings following COVID-19 hospitalization: A prospective longitudinal cohort study

Cited by 8 publications

References 45 publications

Thoracic ultrasonographic and clinical findings at 12-month follow-up of patients admitted with COVID-19

Thoracic ultrasonographic and clinical findings at 12-month follow-up of patients admitted with COVID-19

Point-of-Care Ultrasound of Post-acute COVID-19 Syndrome: A Prospective Cohort Study

Usefulness of C2HEST Score in Predicting Clinical Outcomes of COVID-19 in Heart Failure and Non-Heart-Failure Cohorts

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