# Point-of-care lung ultrasound predicts hyperferritinemia and hospitalization, but not elevated troponin in SARS-CoV-2 viral pneumonitis in children

## TL;DR

Point-of-care lung ultrasound can predict hospitalization and hyperferritinemia in children with SARS-CoV-2 pneumonitis but not elevated troponin.

## Contribution

The study identifies lung ultrasound as a predictor of specific lab abnormalities and hospitalization in SARS-CoV-2-positive children.

## Key findings

- Lung ultrasound abnormalities predicted hospitalization with a threshold effect in SARS-CoV-2-positive patients.
- Ferritin, LDH, and transaminases were significantly associated with lung ultrasound abnormalities in SARS-CoV-2-positive patients.
- CRP and troponin elevations were not reliably predicted by lung ultrasound in SARS-CoV-2-positive patients.

## Abstract

SARS-CoV-2 often causes viral pneumonitis, hyperferritinemia, elevations in D-dimer, lactate dehydrogenase (LDH), transaminases, troponin, CRP, and other inflammatory markers. Lung ultrasound is increasingly used to diagnose and stratify viral pneumonitis severity. We retrospectively reviewed 427 visits in patients aged 14 days to 21 years who had had a point-of-care lung ultrasound in our pediatric emergency department from 30/November/2019 to 14/August/2021. Lung ultrasounds were categorized using a 6-point ordinal scale. Lung ultrasound abnormalities predicted increased hospitalization with a threshold effect. Increasingly abnormal laboratory values were associated with decreased discharge from the ED and increased admission to the ward and ICU. Among patients SARS-CoV-2 positive patients ferritin, LDH, and transaminases, but not CRP or troponin were significantly associated with abnormalities on lung ultrasound and also with threshold effects. This effect was not demonstrated in SARS-CoV-2 negative patients. D-Dimer, CRP, and troponin were sometimes elevated even when the lung ultrasound was normal.