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?:abstract
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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 = 0 048), 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 = 0 03) were mortality predictors Non-survivors had increased incidence of pulmonary abnormalities (B-lines, pleural line irregularities, and consolidations) compared to survivors (p < 0 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
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