Lung Ultrasound Patterns and Clinical-Laboratory Correlates during COVID-19 Pneumonia: A Retrospective Study from North East Italy

Senter, Riccardo; Capone, Federico; Pasqualin, Stefano; Cerruti, Lorenzo; Molinari, Leonardo; Fonte Basso, Elisa; Zanforlin, Nicolò; Previato, Lorenzo; Toffolon, Alessandro; Sensi, Caterina; Arcidiacono, Gaetano; Gorgi, Davide; Ippolito, Renato; Nessi, Enrico; Pettenella, Pietro; Cellini, Andrea; Fossa, Claudio; Vania, Eleonora; Gardin, Samuele; Sukthi, Andi; Luise, Dora; Giordani, Maria Teresa; Zanatta, Mirko; Savino, Sandro; Cianci, Vito; Sattin, Andrea; Maria, Anna; Vianello, Andrea; Pesavento, Raffaele; Giannini, Sandro; Avogaro, Angelo; Vettor, Roberto; Fadini, Gian Paolo; Saller, Alois

Background and Aim. Lung ultrasound (LUS) is a convenient imaging modality in the setting of coronavirus disease-19 (COVID-19) because it is easily available, can be performed bedside and repeated over time. We herein examined LUS patterns in relation to disease severity and disease stage among patients with COVID-19 pneumonia. Methods. We performed a retrospective case series analysis of patients with confirmed SARS-CoV-2 infection who were admitted to the hospital because of pneumonia. We recorded history, clinical parameters and medications. LUS was performed and scored in a standardized fashion by experienced operators, with evaluation of up to 12 lung fields, reporting especially on B-lines and consolidations. Results. We included 96 patients, 58.3% men, with a mean age of 65.9 years. Patients with a high-risk quick COVID-19 severity index (qCSI) were older and had worse outcomes, especially for the need for high-flow oxygen. B-lines and consolidations were located mainly in the lower posterior lung fields. LUS patterns for B-lines and consolidations were significantly worse in all lung fields among patients with high versus low qCSI. B-lines and consolidations were worse in the intermediate disease stage, from day 7 to 13 after onset of symptoms. While consolidations correlated more with inflammatory biomarkers, B-lines correlated more with end-organ damage, including extrapulmonary involvement. Conclusions. LUS patterns provide a comprehensive evaluation of patients with COVID-19 pneumonia that correlated with severity and dynamically reflect disease stage. LUS patterns may reflect different pathophysiological processes related to inflammation or tissue damage; consolidations may represent a more specific sign of localized disease, whereas B-lines seem to be also dependent upon generalized illness due to SARS-CoV-2 infection.