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Abstract: PO0872

Point-of-Care Ultrasound Findings in Patients with COVID-19 and AKI

Session Information

Category: Coronavirus (COVID-19)

  • 000 Coronavirus (COVID-19)

Authors

  • Lindsay-McGinn, Forrest F., University of Pennsylvania, Philadelphia, Pennsylvania, United States
  • Potluri, Vishnu S., University of Pennsylvania, Philadelphia, Pennsylvania, United States
  • Lohani, Sadichhya, University of Pennsylvania, Philadelphia, Pennsylvania, United States
  • Centeno, Claire A., University of Pennsylvania, Philadelphia, Pennsylvania, United States
  • Morganroth, Jennifer, University of Pennsylvania, Philadelphia, Pennsylvania, United States
  • Moore, Christy, University of Pennsylvania, Philadelphia, Pennsylvania, United States
  • Teran, Felipe, University of Pennsylvania, Philadelphia, Pennsylvania, United States
  • Reisinger, Nathaniel C., University of Pennsylvania, Philadelphia, Pennsylvania, United States
Background

More than one third of patients presenting with COVID-19 in the United States develop acute kidney injury (AKI) and many require dialysis. AKI portends a poor prognosis particularly if dialysis is required. Point-of-care ultrasound (POCUS) is a valuable tool for the evaluation of AKI particularly for assessment of volume status. Here we describe clinical and ultrasonographic characteristics of COVID-19 patients with AKI.

Methods

This cohort includes prospectively enrolled adult patients with confirmed COVID-19 who developed AKI as part of their hospital encounter in April and May of 2020. Ultrasounds were performed using a published 12-point lung and limited 5-view cardiac protocol. The diagnosis of AKI was determined by a nephrologist. The institutional review board at the University of Pennsylvania approved this study.

Results

33 patients were included. 79% were African-American. 56% were female. Median age was 65 and average BMI 30±9. 29% had CKD, 47% had diabetes, 68% had hypertension and 24% had heart failure. 12 experienced stage 1 AKI, 4 had stage 2 AKI, 17 had stage 3 AKI, and 10 required dialysis. 16 patients (52%) had a diagnosis of acute tubular injury. 18 (53%) had significant proteinuria, 24 (71%) had hematuria, and 20 (59%) had pyuria. 73% required ICU admission, 15 were discharged and 5 died. 25 of 33 had a left ventricular ejection fraction (EF) assessment, 22 had an EF >55%, 4 had an EF 30-55% and 1 had an EF <30%. 23 had an assessment of their inferior vena cava (IVC). 8 had a normal IVC, while 6 had a full, non-collapsing IVC and 9 had a flat IVC. 5 had pericardial effusion. 2 had right-ventricular dysfunction. The lung US assessments included an average of 10 of the 12 specified zones, favoring the anterior zones. An average of 3.8 zones per scan showed scattered b-lines, 3.1 zones showed confluent b-lines and 1.0 zone showed consolidations. 3 patients had pleural effusion.

Conclusion

Our study describes cardiac and lung US findings in patients who experience AKI during their COVID-19 course. Most patients had multifocal b-line findings. Most had normal ejection fractions but there was wide variation in IVC distension. More studies are needed to determine if ultrasound can guide fluid management or identify reversible causes of AKI.