Coronavirus | August 10, 2022 | FREE
Most ACP Hospitalist content is available exclusively to ACP Members. This article is free to the public.

Latest COVID-19 research looks at lung ultrasound, CVST and VTE risk, visitation policies

Recent studies offered a new method for using lung ultrasound to assess COVID-19 patients, assessed risk of central venous sinus thrombosis (CVST), and looked at a lab test to help predict venous thromboembolism (VTE) and at the effects of restricting visitors.

A study offered a new method for using lung ultrasound (LUS) to assess the severity of acute respiratory distress syndrome due to COVID-19. The observational study, published by CHEST on July 30, enrolled a convenience sample of 179 patients seen in an ED who had confirmed COVID-19 and pneumonia based on bedside LUS and CT scan. Researchers developed an alternative LUS method based on grading the percentage of extension of typical signs of COVID-19 pneumonia on the lung surface (which they called LUSext). The study found that LUSext was feasible in all patients, and the average time to perform it was five minutes. LUSext and volumetric measures of the lesions on CT were positively correlated with each other and negatively with PaO2/FiO2. The authors concluded that LUSext is a valid measure of the severity of lesions when compared to CT scan, and future research should further investigate its clinical and prognostic impacts. “In our experience, this new LUS scoring might indicate the necessity for a more careful follow-up and hospitalization in patients with a borderline condition and without signs of respiratory failure, who show more severe grades of extension of pneumonia,” they wrote.

Cerebral venous sinus thrombosis (CVST) was relatively common among patients hospitalized with COVID-19, according to a study published by Stroke on Aug. 3. Review of electronic medical records for 91,727 patients found 22 new CVST diagnoses, an incidence of 231 per 1,000,000 person-years. Women under age 50 years had the highest incidence, but in-hospital death was more likely in older patients (45.5% in those ≥50 years vs. 0% <50 years) and men (44.4% vs. 7.7%). “The incidence of CVST in this population appears higher than rates reported in both the general (non–COVID-19) population as well as COVID-19 vaccine-induced thrombotic thrombocytopenia–related CVST,” said the study authors, who noted that the findings were gathered in patients hospitalized before vaccines were available, so may not apply to outpatients with COVID-19 or vaccinated patients. Limitations of the study include the relatively small number of CVST cases.

Levels of soluble urokinase plasminogen activator receptor (suPAR) can help assess venous thromboembolism (VTE) risk in patients with COVID-19, according to a study published by the Journal of the American Heart Association on Aug. 4. An analysis of 1,960 hospitalized patients found that VTE occurred in 163 (8%) patients and was associated with higher suPAR and D-dimer levels. After adjustment for variables including D-dimer, the odds of VTE were 168% higher in the third suPAR tertile compared with the first. The authors calculated that combining D-dimer and suPAR cutoffs of 1 mg/L and <11 ng/mL, respectively, could identify the 41% of patients with only 3.6% risk of VTE. The results suggest that “suPAR may account for the excessive thromboembolic risk in COVID-19, possibly secondary to immunothrombosis” and that the test could be used in conjunction with D-dimer for improved VTE risk stratification in patients with COVID-19.

A study published by the Journal of Hospital Medicine on Aug. 3 described the effects of hospital visitation restrictions on patients and their caregivers. Using data from the electronic health record, researchers compared communication during hospitalizations for cancer or heart failure before visitor restrictions (n=100) and during restrictions (n=100). They found that caregivers communicated less frequently with the medical team, were less likely to receive discharge counseling, and were more likely to have no contact with the medical team during periods with restrictions. Interviews with a subsample of those affected by restrictions found that caregivers and patients reported emotional distress, conflict, and decreased perception of care quality. “Our findings may generalize to non-pandemic settings where distance hinders in-person access for caregivers,” said the authors, who suggested that solutions could include scheduled contact with caregivers and increased use of videoconferencing. “It is also uncertain whether the benefits of visitor restrictions outweigh the costs, given the unclear evidence that visitor restrictions decrease COVID-19 outbreaks,” they wrote.