Prognostic Value of Lung Ultrasonography in Older Nursing Home Residents Affected by COVID-19

Objectives: Lung ultrasonographic (LUS) imaging may play an important role in the management of patients with COVID-19-associated lung injury, particularly in some special populations. However, data regarding the prognostic role of the LUS in nursing home residents, one of the populations most affected by COVID-19, are not still available.

Design: Retrospective.

Settings and participants: Nursing home residents affected by COVID-19 were followed up with an LUS from April 8 to May 14, 2020, in Chioggia, Venice.

Methods: COVID-19 was diagnosed through a nasopharyngeal swab. LUS results were scored using a 12-zone method. For each of the 12 zones (2 posterior, 2 anterior, 2 lateral, for both left and right lungs), the possible score ranged from 0 to 3 (1 = presence of B lines, separated, with <50% of space from the pleural line; 2 = presence of B lines, separated, with >50% of space from the pleural line; 3 = lung thickening with tissuelike aspect). The total score ranged from 0 to 36. Mortality was assessed using administrative data. Data regarding accuracy (and related parameters) were reported.

Results: Among 175 nursing home residents, 48 (mean age: 84.1 years; mainly female) were affected by COVID-19. Twelve died during the follow-up period. The mean LUS score was 3. The area under the curve of LUS in predicting mortality was 0.603 [95% confidence interval (CI): 0.419-0.787], and it increased to 0.725 (95% CI: 0.41-0.99) after including follow-up LUS controls. Taking an LUS score ≥4 as exposure variable and mortality as outcome, the sensitivity was 58.33% and specificity 63.89%, with a positive likelihood ratio of 1.62 and a negative of 0.65.

Conclusions and implications: LUS is able to significantly predict mortality in nursing home residents affected by COVID-19, suggesting that this simple tool can be routinely used in this setting instead of more invasive techniques available only in hospital.