Lung ultrasound findings in hospitalized COVID-19 patients in relation to venous thromboembolic events: the ECHOVID-19 study

Kristoffer Grundtvig Skaarup; Mats Christian Højbjerg Lassen; Caroline Espersen; Jannie Nørgaard Lind; Niklas Dyrby Johansen; Morten Sengeløv; Alia Saed Alhakak; Anne Bjerg Nielsen; Kirstine Ravnkilde; Raphael Hauser; Liv Borum Schöps; Eva Holt; Henning Bundgaard; Christian Hassager; Reza Jabbari; Jørn Carlsen; Ole Kirk; Uffe Bodtger; Matias Greve Lindholm; Lothar Wiese; Ole Peter Kristiansen; Emil Schwarz Walsted; Olav Wendelboe Nielsen; Birgitte Lindegaard; Niels Tønder; Klaus Nielsen Jeschke; Charlotte Suppli Ulrik; Morten Lamberts; Pradeesh Sivapalan; Jannik Pallisgaard; Gunnar Gislason; Kasper Iversen; Jens Ulrik Stæhr Jensen; Morten Schou; Søren Helbo Skaarup; Elke Platz; Tor Biering-Sørensen

doi:10.1007/s40477-021-00605-8

Lung ultrasound findings in hospitalized COVID-19 patients in relation to venous thromboembolic events: the ECHOVID-19 study

Kristoffer Grundtvig Skaarup, Mats Christian Højbjerg Lassen, Caroline Espersen, Jannie Nørgaard Lind, Niklas Dyrby Johansen, Morten Sengeløv, Alia Saed Alhakak, Anne Bjerg Nielsen, Kirstine Ravnkilde, Raphael Hauser, Liv Borum Schöps, Eva Holt, Henning Bundgaard, Christian Hassager, Reza Jabbari, Jørn Carlsen, Ole Kirk, Uffe Bodtger, Matias Greve Lindholm, Lothar WieseOle Peter Kristiansen, Emil Schwarz Walsted, Olav Wendelboe Nielsen, Birgitte Lindegaard, Niels Tønder, Klaus Nielsen Jeschke, Charlotte Suppli Ulrik, Morten Lamberts, Pradeesh Sivapalan, Jannik Pallisgaard, Gunnar Gislason, Kasper Iversen, Jens Ulrik Stæhr Jensen, Morten Schou, Søren Helbo Skaarup, Elke Platz, Tor Biering-Sørensen^*

^*Corresponding author for this work

Research output: Contribution to journal › Article › Research › peer-review

Abstract

PURPOSE: Several studies have reported thromboembolic events to be common in severe COVID-19 cases. We sought to investigate the relationship between lung ultrasound (LUS) findings in hospitalized COVID-19 patients and the development of venous thromboembolic events (VTE).

METHODS: A total of 203 adults were included from a COVID-19 ward in this prospective multi-center study (mean age 68.6 years, 56.7% men). All patients underwent 8-zone LUS, and all ultrasound images were analyzed off-line blinded. Several LUS findings were investigated (total number of B-lines, B-line score, and LUS-scores).

RESULTS: Median time from admission to LUS examination was 4 days (IQR: 2, 8). The median number of B-lines was 12 (IQR: 8, 18), and 44 (21.7%) had a positive B-line score. During hospitalization, 17 patients developed VTE (4 deep-vein thrombosis, 15 pulmonary embolism), 12 following and 5 prior to LUS. In fully adjusted multivariable Cox models (excluding participants with VTE prior to LUS), all LUS parameters were significantly associated with VTE (total number of B-lines: HR = 1.14, 95% CI (1.03, 1.26) per 1 B-line increase), positive B-line score: HR = 9.79, 95% CI (1.87, 51.35), and LUS-score: HR = 1.51, 95% CI (1.10, 2.07), per 1-point increase). The B-line score and LUS-score remained significantly associated with VTE in sensitivity analyses.

CONCLUSION: In hospitalized COVID-19 patients, pathological LUS findings were common, and the total number of B-lines, B-line score, and LUS-score were all associated with VTE. These findings indicate that the LUS examination may be useful in risk stratification and the clinical management of COVID-19. These findings should be considered hypothesis generating.

GOV ID: NCT04377035.

Original language	English
Pages (from-to)	457-467
Number of pages	11
Journal	Journal of ultrasound
Volume	25
Issue number	3
Early online date	2 Jul 2021
DOIs	https://doi.org/10.1007/s40477-021-00605-8
Publication status	Published - Sept 2022

Bibliographical note

Keywords

Adult
Aged
COVID-19/diagnostic imaging
Female
Humans
Lung/diagnostic imaging
Male
Prospective Studies
Ultrasonography/methods
Venous Thromboembolism/diagnostic imaging

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10.1007/s40477-021-00605-8

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Skaarup, K. G., Lassen, M. C. H., Espersen, C., Lind, J. N., Johansen, N. D., Sengeløv, M., Alhakak, A. S., Nielsen, A. B., Ravnkilde, K., Hauser, R., Schöps, L. B., Holt, E., Bundgaard, H., Hassager, C., Jabbari, R., Carlsen, J., Kirk, O., Bodtger, U., Lindholm, M. G., ... Biering-Sørensen, T. (2022). Lung ultrasound findings in hospitalized COVID-19 patients in relation to venous thromboembolic events: the ECHOVID-19 study. Journal of ultrasound, 25(3), 457-467. https://doi.org/10.1007/s40477-021-00605-8

@article{1b91b6e89ed640d6ad111e1136a5f32e,

title = "Lung ultrasound findings in hospitalized COVID-19 patients in relation to venous thromboembolic events: the ECHOVID-19 study",

abstract = "PURPOSE: Several studies have reported thromboembolic events to be common in severe COVID-19 cases. We sought to investigate the relationship between lung ultrasound (LUS) findings in hospitalized COVID-19 patients and the development of venous thromboembolic events (VTE).METHODS: A total of 203 adults were included from a COVID-19 ward in this prospective multi-center study (mean age 68.6 years, 56.7% men). All patients underwent 8-zone LUS, and all ultrasound images were analyzed off-line blinded. Several LUS findings were investigated (total number of B-lines, B-line score, and LUS-scores).RESULTS: Median time from admission to LUS examination was 4 days (IQR: 2, 8). The median number of B-lines was 12 (IQR: 8, 18), and 44 (21.7%) had a positive B-line score. During hospitalization, 17 patients developed VTE (4 deep-vein thrombosis, 15 pulmonary embolism), 12 following and 5 prior to LUS. In fully adjusted multivariable Cox models (excluding participants with VTE prior to LUS), all LUS parameters were significantly associated with VTE (total number of B-lines: HR = 1.14, 95% CI (1.03, 1.26) per 1 B-line increase), positive B-line score: HR = 9.79, 95% CI (1.87, 51.35), and LUS-score: HR = 1.51, 95% CI (1.10, 2.07), per 1-point increase). The B-line score and LUS-score remained significantly associated with VTE in sensitivity analyses.CONCLUSION: In hospitalized COVID-19 patients, pathological LUS findings were common, and the total number of B-lines, B-line score, and LUS-score were all associated with VTE. These findings indicate that the LUS examination may be useful in risk stratification and the clinical management of COVID-19. These findings should be considered hypothesis generating.GOV ID: NCT04377035.",

keywords = "Adult, Aged, COVID-19/diagnostic imaging, Female, Humans, Lung/diagnostic imaging, Male, Prospective Studies, Ultrasonography/methods, Venous Thromboembolism/diagnostic imaging",

author = "Skaarup, {Kristoffer Grundtvig} and Lassen, {Mats Christian H{\o}jbjerg} and Caroline Espersen and Lind, {Jannie N{\o}rgaard} and Johansen, {Niklas Dyrby} and Morten Sengel{\o}v and Alhakak, {Alia Saed} and Nielsen, {Anne Bjerg} and Kirstine Ravnkilde and Raphael Hauser and Sch{\"o}ps, {Liv Borum} and Eva Holt and Henning Bundgaard and Christian Hassager and Reza Jabbari and J{\o}rn Carlsen and Ole Kirk and Uffe Bodtger and Lindholm, {Matias Greve} and Lothar Wiese and Kristiansen, {Ole Peter} and Walsted, {Emil Schwarz} and Nielsen, {Olav Wendelboe} and Birgitte Lindegaard and Niels T{\o}nder and Jeschke, {Klaus Nielsen} and Ulrik, {Charlotte Suppli} and Morten Lamberts and Pradeesh Sivapalan and Jannik Pallisgaard and Gunnar Gislason and Kasper Iversen and Jensen, {Jens Ulrik St{\ae}hr} and Morten Schou and Skaarup, {S{\o}ren Helbo} and Elke Platz and Tor Biering-S{\o}rensen",

note = "{\textcopyright} 2021. Societ{\`a} Italiana di Ultrasonologia in Medicina e Biologia (SIUMB).",

year = "2022",

month = sep,

doi = "10.1007/s40477-021-00605-8",

language = "English",

volume = "25",

pages = "457--467",

journal = "Journal of ultrasound",

issn = "1876-7931",

publisher = "Springer International Publishing AG",

number = "3",

}

Skaarup, KG, Lassen, MCH, Espersen, C, Lind, JN, Johansen, ND, Sengeløv, M, Alhakak, AS, Nielsen, AB, Ravnkilde, K, Hauser, R, Schöps, LB, Holt, E, Bundgaard, H, Hassager, C, Jabbari, R, Carlsen, J, Kirk, O, Bodtger, U , Lindholm, MG , Wiese, L, Kristiansen, OP, Walsted, ES, Nielsen, OW, Lindegaard, B, Tønder, N, Jeschke, KN, Ulrik, CS, Lamberts, M, Sivapalan, P, Pallisgaard, J, Gislason, G, Iversen, K, Jensen, JUS, Schou, M, Skaarup, SH, Platz, E & Biering-Sørensen, T 2022, 'Lung ultrasound findings in hospitalized COVID-19 patients in relation to venous thromboembolic events: the ECHOVID-19 study', Journal of ultrasound, vol. 25, no. 3, pp. 457-467. https://doi.org/10.1007/s40477-021-00605-8

TY - JOUR

T1 - Lung ultrasound findings in hospitalized COVID-19 patients in relation to venous thromboembolic events

T2 - the ECHOVID-19 study

AU - Skaarup, Kristoffer Grundtvig

AU - Lassen, Mats Christian Højbjerg

AU - Espersen, Caroline

AU - Lind, Jannie Nørgaard

AU - Johansen, Niklas Dyrby

AU - Sengeløv, Morten

AU - Alhakak, Alia Saed

AU - Nielsen, Anne Bjerg

AU - Ravnkilde, Kirstine

AU - Hauser, Raphael

AU - Schöps, Liv Borum

AU - Holt, Eva

AU - Bundgaard, Henning

AU - Hassager, Christian

AU - Jabbari, Reza

AU - Carlsen, Jørn

AU - Kirk, Ole

AU - Bodtger, Uffe

AU - Lindholm, Matias Greve

AU - Wiese, Lothar

AU - Kristiansen, Ole Peter

AU - Walsted, Emil Schwarz

AU - Nielsen, Olav Wendelboe

AU - Lindegaard, Birgitte

AU - Tønder, Niels

AU - Jeschke, Klaus Nielsen

AU - Ulrik, Charlotte Suppli

AU - Lamberts, Morten

AU - Sivapalan, Pradeesh

AU - Pallisgaard, Jannik

AU - Gislason, Gunnar

AU - Iversen, Kasper

AU - Jensen, Jens Ulrik Stæhr

AU - Schou, Morten

AU - Skaarup, Søren Helbo

AU - Platz, Elke

AU - Biering-Sørensen, Tor

PY - 2022/9

Y1 - 2022/9

N2 - PURPOSE: Several studies have reported thromboembolic events to be common in severe COVID-19 cases. We sought to investigate the relationship between lung ultrasound (LUS) findings in hospitalized COVID-19 patients and the development of venous thromboembolic events (VTE).METHODS: A total of 203 adults were included from a COVID-19 ward in this prospective multi-center study (mean age 68.6 years, 56.7% men). All patients underwent 8-zone LUS, and all ultrasound images were analyzed off-line blinded. Several LUS findings were investigated (total number of B-lines, B-line score, and LUS-scores).RESULTS: Median time from admission to LUS examination was 4 days (IQR: 2, 8). The median number of B-lines was 12 (IQR: 8, 18), and 44 (21.7%) had a positive B-line score. During hospitalization, 17 patients developed VTE (4 deep-vein thrombosis, 15 pulmonary embolism), 12 following and 5 prior to LUS. In fully adjusted multivariable Cox models (excluding participants with VTE prior to LUS), all LUS parameters were significantly associated with VTE (total number of B-lines: HR = 1.14, 95% CI (1.03, 1.26) per 1 B-line increase), positive B-line score: HR = 9.79, 95% CI (1.87, 51.35), and LUS-score: HR = 1.51, 95% CI (1.10, 2.07), per 1-point increase). The B-line score and LUS-score remained significantly associated with VTE in sensitivity analyses.CONCLUSION: In hospitalized COVID-19 patients, pathological LUS findings were common, and the total number of B-lines, B-line score, and LUS-score were all associated with VTE. These findings indicate that the LUS examination may be useful in risk stratification and the clinical management of COVID-19. These findings should be considered hypothesis generating.GOV ID: NCT04377035.

AB - PURPOSE: Several studies have reported thromboembolic events to be common in severe COVID-19 cases. We sought to investigate the relationship between lung ultrasound (LUS) findings in hospitalized COVID-19 patients and the development of venous thromboembolic events (VTE).METHODS: A total of 203 adults were included from a COVID-19 ward in this prospective multi-center study (mean age 68.6 years, 56.7% men). All patients underwent 8-zone LUS, and all ultrasound images were analyzed off-line blinded. Several LUS findings were investigated (total number of B-lines, B-line score, and LUS-scores).RESULTS: Median time from admission to LUS examination was 4 days (IQR: 2, 8). The median number of B-lines was 12 (IQR: 8, 18), and 44 (21.7%) had a positive B-line score. During hospitalization, 17 patients developed VTE (4 deep-vein thrombosis, 15 pulmonary embolism), 12 following and 5 prior to LUS. In fully adjusted multivariable Cox models (excluding participants with VTE prior to LUS), all LUS parameters were significantly associated with VTE (total number of B-lines: HR = 1.14, 95% CI (1.03, 1.26) per 1 B-line increase), positive B-line score: HR = 9.79, 95% CI (1.87, 51.35), and LUS-score: HR = 1.51, 95% CI (1.10, 2.07), per 1-point increase). The B-line score and LUS-score remained significantly associated with VTE in sensitivity analyses.CONCLUSION: In hospitalized COVID-19 patients, pathological LUS findings were common, and the total number of B-lines, B-line score, and LUS-score were all associated with VTE. These findings indicate that the LUS examination may be useful in risk stratification and the clinical management of COVID-19. These findings should be considered hypothesis generating.GOV ID: NCT04377035.

KW - Adult

KW - Aged

KW - COVID-19/diagnostic imaging

KW - Female

KW - Humans

KW - Lung/diagnostic imaging

KW - Male

KW - Prospective Studies

KW - Ultrasonography/methods

KW - Venous Thromboembolism/diagnostic imaging

U2 - 10.1007/s40477-021-00605-8

DO - 10.1007/s40477-021-00605-8

M3 - Article

C2 - 34213740

SN - 1876-7931

VL - 25

SP - 457

EP - 467

JO - Journal of ultrasound

JF - Journal of ultrasound

IS - 3

ER -

Lung ultrasound findings in hospitalized COVID-19 patients in relation to venous thromboembolic events: the ECHOVID-19 study

Abstract

Bibliographical note

Keywords

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