Residual Lung Injury in Patients Recovering From COVID-19 Critical Illness: A Prospective Longitudinal Point-of-Care Lung Ultrasound Study

Abdulrahman Alharthy; Mohamed Abuhamdah; Abdullah Balhamar; Fahad Faqihi; Nasir Nasim; Shahzad Ahmad; Alfateh Noor; Hani Tamim; Saleh A Alqahtani; Ahad Alhassan Al Saud Bin Abdulaziz Al Saud; Demetrios J Kutsogiannis; Peter G Brindley; Ziad A Memish; Dimitrios Karakitsos; Michael Blaivas

doi:10.1002/jum.15563

Residual Lung Injury in Patients Recovering From COVID-19 Critical Illness: A Prospective Longitudinal Point-of-Care Lung Ultrasound Study

J Ultrasound Med. 2021 Sep;40(9):1823-1838. doi: 10.1002/jum.15563. Epub 2020 Nov 13.

Authors

Abdulrahman Alharthy¹, Mohamed Abuhamdah¹, Abdullah Balhamar¹, Fahad Faqihi¹, Nasir Nasim¹, Shahzad Ahmad¹, Alfateh Noor¹, Hani Tamim², Saleh A Alqahtani³, Ahad Alhassan Al Saud Bin Abdulaziz Al Saud⁴, Demetrios J Kutsogiannis⁵, Peter G Brindley⁵, Ziad A Memish⁶, Dimitrios Karakitsos^{1

7}, Michael Blaivas⁸

Affiliations

¹ Critical Care Department, King Saud Medical City, Riyadh, Saudi Arabia.
² Biostatistics Unit, Clinical Research Institute, American University of Beirut Medical Center, Beirut, Lebanon.
³ Department of Medicine, The Johns Hopkins University Hospital, Baltimore, Maryland, USA.
⁴ Emergency Department, Harvard Medical School, Massachusetts General Hospital, Boston, Massachusetts, USA.
⁵ Critical Care Department, Alberta Health Care Services, Edmonton, Alberta, Canada.
⁶ Research & Innovation Centre, King Saud Medical City, Riyadh, Saudi Arabia.
⁷ Department of Medicine, University of South Carolina School of Medicine, Columbia, South Carolina, USA.
⁸ Department of Emergency Medicine, St. Francis Hospital, Columbus, Georgia, USA.

PMID: 33185316
DOI: 10.1002/jum.15563

Abstract

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.

Keywords: COVID-19 pneumonia; interstitial lung disease; point-of-care LUS; predictive models; residual lung injury; thromboembolic disease.

MeSH terms

COVID-19*
Critical Illness
Humans
Lung / diagnostic imaging
Lung Injury* / diagnostic imaging
Point-of-Care Systems
SARS-CoV-2
Ultrasonography