Lung ultrasound presentation of COVID-19 patients: phenotypes and correlations

Gianmarco Secco, Marzia Delorenzo, Francesco Salinaro, Caterina Zattera, Bruno Barcella, Flavia Resta, Anna Sabena, Giulia Vezzoni, Marco Bonzano, Federica Briganti, Giovanni Cappa, Francesca Zugnoni, Lorenzo Demitry, Francesco Mojoli, Fausto Baldanti, Raffaele Bruno, Stefano Perlini, GERICO (Gruppo Esteso RIcerca COronarovirus) Lung US Pavia Study Group


Bedside lung ultrasound (LUS) can play a role in the setting of the SarsCoV2 pneumonia pandemic. To evaluate the clinical and LUS features of COVID-19 in the ED and their potential prognostic role, a cohort of laboratory-confirmed COVID-19 patients underwent LUS upon admission in the ED. LUS score was derived from 12 fields. A prevalent LUS pattern was assigned depending on the presence of interstitial syndrome only (Interstitial Pattern), or evidence of subpleural consolidations in at least two fields (Consolidation Pattern). The endpoint was 30-day mortality. The relationship between hemogasanalysis parameters and LUS score was also evaluated. Out of 312 patients, only 36 (11.5%) did not present lung involvment, as defined by LUS score < 1. The majority of patients were admitted either in a general ward (53.8%) or in intensive care unit (9.6%), whereas 106 patients (33.9%) were discharged from the ED. In-hospital mortality was 25.3%, and 30-day survival was 67.6%. A LUS score > 13 had a 77.2% sensitivity and a 71.5% specificity (AUC 0.814; p < 0.001) in predicting mortality. LUS alterations were more frequent (64%) in the posterior lower fields. LUS score was related with P/F (R² 0.68; p < 0.0001) and P/F at FiO2 = 21% (R² 0.59; p < 0.0001). The correlation between LUS score and P/F was not influenced by the prevalent ultrasound pattern. LUS represents an effective tool in both defining diagnosis and stratifying prognosis of COVID-19 pneumonia. The correlation between LUS and hemogasanalysis parameters underscores its role in evaluating lung structure and function.

Keywords: COVID-19, Echographic phenotypes, Interstitial pneumonia, LUS score, Interstitial pneumonia.

Internal and Emergency Medicine (2021) 16:1317–1327.
Epub 2021 Mar 1.
DOI: 10.1007/s11739-020-02620-9
© 2021. The Author(s)