The clinical value of bedside ultrasound in predicting the severity of coronavirus disease-19 (COVID-19)

Jianzhong Xian; Xiaofeng Pei; Wuzhu Lu; Haihong Zhong; Yuhong Lin; Hongjun Jin; Zhongzhen Su

doi:10.21037/atm-20-7944

The clinical value of bedside ultrasound in predicting the severity of coronavirus disease-19 (COVID-19)

Ann Transl Med. 2021 Feb;9(4):336. doi: 10.21037/atm-20-7944.

Authors

Jianzhong Xian^{1

2}, Xiaofeng Pei³, Wuzhu Lu¹, Haihong Zhong⁴, Yuhong Lin¹, Hongjun Jin², Zhongzhen Su^{1

2}

Affiliations

¹ Department of Ultrasound, Fifth Affiliated Hospital of Sun Yat-sen University, Zhuhai, China.
² Guangdong Provincial Key Laboratory of Biomedical Imaging and Guangdong Provincial Engineering Research Center of Molecular Imaging, Fifth Affiliated Hospital of Sun Yat-sen University, Zhuhai, China.
³ Department of Thoracic Oncology, the Fifth Affiliated Hospital of Sun Yat-sen University, Zhuhai, China.
⁴ Department of Radiology, Fifth Affiliated Hospital of Sun Yat-sen University, Zhuhai, China.

Abstract

Background: To summarise the ultrasound manifestations of coronavirus disease-19 (COVID-19) patients with lung lesions and explore the clinical value of bedside ultrasound in the identification of patients at risk of progression to severe disease.

Methods: This retrospective study enrolled 31 patients with COVID-19 who were admitted to our hospital from January 18 to February 5, 2020. Lung ultrasounds were performed in all cases to evaluate the ultrasound manifestations of the patient's lung lesions and to determine the lung ultrasound scores (LUS). The Cox proportional hazards regression model was used for the multifactor analysis of 7 candidate parameters, including the LUS and the oxygenation index (PaO₂/FiO₂). Receiver operating characteristic (ROC) curve analysis was performed to evaluate the predictive value of the LUS.

Results: Lung ultrasound images of COVID-19 patients mainly reflected the presence of interstitial pulmonary lesions (90.3%, 28/31). The lung lesions were primarily distributed in the subpleural and peripheral pulmonary zones. Multivariate analyses identified the oxygenation index, the LUS, and the lymphocyte count as factors related to the progression to severe-critical disease in COVID-19 patients (P<0.05). With a cut-off value of 9.5, the area under the ROC curve was 0.910. The LUS showed a sensitivity and specificity of 81.3% and 93.0%, respectively (P≤0.001), with an overall accuracy of 75%.

Conclusions: The lung ultrasound findings in COVID-19 patients were mainly and specifically manifested as interstitial lesions involving the peripheral zones of the lung. In addition, ultrasound imaging could predict the likelihood of COVID-19 patients progressing to severe disease, thereby allowing for early intervention. Thus, lung ultrasounds have great clinical value in monitoring and evaluating COVID-19 patients.

Keywords: Coronavirus disease-19 (COVID-19); bedside ultrasound; lung ultrasound score (LUS); pneumonia; prediction; severe.