Lung Ultrasound as a First-Line Test in the Evaluation of Post-COVID-19 Pulmonary Sequelae

David Clofent; Eva Polverino; Almudena Felipe; Galo Granados; Marta Arjona-Peris; Jordi Andreu; Ana L Sánchez-Martínez; Diego Varona; Laura Cabanzo; Jose M Escudero; Antonio Álvarez; Karina Loor; Xavier Muñoz; Mario Culebras

doi:10.3389/fmed.2021.815732

Lung Ultrasound as a First-Line Test in the Evaluation of Post-COVID-19 Pulmonary Sequelae

Front Med (Lausanne). 2022 Jan 13:8:815732. doi: 10.3389/fmed.2021.815732. eCollection 2021.

Authors

David Clofent^{1

2}, Eva Polverino^{1

2}, Almudena Felipe^{1

2}, Galo Granados^{1

2}, Marta Arjona-Peris^{1

2}, Jordi Andreu³, Ana L Sánchez-Martínez³, Diego Varona³, Laura Cabanzo³, Jose M Escudero³, Antonio Álvarez^{1

2

4}, Karina Loor^{1

2}, Xavier Muñoz^{1

2

4}, Mario Culebras^{1

2}

Affiliations

¹ Department of Respiratory Medicine, Vall D'Hebron University Hospital, Barcelona, Spain.
² Vall D'Hebron Institut de Recerca (VHIR), Barcelona, Spain.
³ Radiology Department, Vall D'Hebron University Hospital, Barcelona, Spain.
⁴ CIBER Enfermedades Respiratorias (CIBERES), Barcelona, Spain.

Abstract

Background: Interstitial lung sequelae are increasingly being reported in survivors of COVID-19 pneumonia. An early detection of these lesions may help prevent the development of irreversible lung fibrosis. Lung ultrasound (LUS) has shown high diagnostic accuracy in interstitial lung disease (ILD) and could likely be used as a first-line test for post-COVID-19 lung sequelae. Methods: Single-center observational prospective study. Follow-up assessments of consecutive patients hospitalized for COVID-19 pneumonia were conducted 2-5 months after the hospitalization. All patients underwent pulmonary function tests (PFTs), high-resolution computed tomography (HRCT), and LUS. Radiological alterations in HRCT were quantified using the Warrick score. The LUS score was obtained by evaluating the presence of pathological B-lines in 12 thoracic areas (range, 0-12). The correlation between the LUS and Warrick scores was analyzed. Results: Three hundred and fifty-two patients who recovered from COVID-19 pneumonia were recruited between July and September 2020. At follow-up, dyspnea was the most frequent symptom (69.3%). FVC and DLCO alterations were present in 79 (22.4%) and 234 (66.5%) patients, respectively. HRCT showed relevant interstitial lung sequelae (RILS) in 154 (43.8%) patients (Warrick score ≥ 7). The LUS score was strongly correlated with the HRCT Warrick score (r = 0.77) and showed a moderate inverse correlation with DLCO (r = -0.55). The ROC curve analysis revealed that a LUS score ≥ 3 indicated an excellent ability to discriminate patients with RILS (sensitivity, 94.2%; specificity, 81.8%; negative predictive value, 94.7%). Conclusions: LUS could be implemented as a first-line procedure in the evaluation of Post-COVID-19 interstitial lung sequelae. A normal LUS examination rules out the presence of these sequelae in COVID-19 survivors, avoiding the need for additional diagnostic tests such as HRCT.

Keywords: COVID-19; SARS-CoV-2; interstitial lung disease (ILD); lung ultrasound (LUS); pulmonary sequelae; ultrasonography.