Systematic lung ultrasound in Omicron-type vs. wild-type COVID-19

Ariel Banai, Lior Lupu, Aviel Shetrit, Aviram Hochstadt, Yael Lichter, Erez Levi, Yishay Szekely, Nadav Schellekes, Tammy Jacoby, David Zahler, Tamar Itach, Philippe Taieb, Sheizaf Gefen, Dana Viskin, Lia Shidlansik, Amos Adler, Ekaterina Levitsky, Ofer Havakuk, Shmuel Banai, Eihab GhantousYan Topilsky

Research output: Contribution to journalArticlepeer-review


Aims: Preliminary data suggested that patients with Omicron-type-Coronavirus-disease-2019 (COVID-19) have less severe lung disease compared with the wild-type-variant. We aimed to compare lung ultrasound (LUS) parameters in Omicron vs. wild-type COVID-19 and evaluate their prognostic implications. Methods and results: One hundred and sixty-two consecutive patients with Omicron-type-COVID-19 underwent LUS within 48 h of admission and were compared with propensity-matched wild-type patients (148 pairs). In the Omicron patients median, first and third quartiles of the LUS-score was 5 [2-12], and only 9% had normal LUS. The majority had either mild (≤5; 37%) or moderate (6-15; 39%), and 15% (≥15) had severe LUS-score. Thirty-six percent of patients had patchy pleural thickening (PPT). Factors associated with LUS-score in the Omicron patients included ischaemic-heart-disease, heart failure, renal-dysfunction, and C-reactive protein. Elevated left-filling pressure or right-sided pressures were associated with the LUS-score. Lung ultrasound-score was associated with mortality [odds ratio (OR): 1.09, 95% confidence interval (CI): 1.01-1.18; P = 0.03] and with the combined endpoint of mortality and respiratory failure (OR: 1.14, 95% CI: 1.07-1.22; P < 0.0001). Patients with the wild-type variant had worse LUS characteristics than the matched Omicron-type patients (PPT: 90 vs. 34%; P < 0.0001 and LUS-score: 8 [5, 12] vs. 5 [2, 10], P = 0.004), irrespective of disease severity. When matched only to the 31 non-vaccinated Omicron patients, these differences were attenuated. Conclusion: Lung ultrasound-score is abnormal in the majority of hospitalized Omicron-type patients. Patchy pleural thickening is less common than in matched wild-type patients, but the difference is diminished in the non-vaccinated Omicron patients. Nevertheless, even in this milder form of the disease, the LUS-score is associated with poor in-hospital outcomes.

Original languageEnglish
Pages (from-to)59-67
Number of pages9
JournalEuropean Heart Journal Cardiovascular Imaging
Issue number1
StatePublished - 1 Jan 2023


  • COVID-19
  • clinical outcomes
  • lung ultrasound
  • risk stratification


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