Dataset Information

Prognostic value of bedside lung ultrasound score in patients with COVID-19.

ABSTRACT:

Background

Bedside lung ultrasound (LUS) has emerged as a useful and non-invasive tool to detect lung involvement and monitor changes in patients with coronavirus disease 2019 (COVID-19). However, the clinical significance of the LUS score in patients with COVID-19 remains unknown. We aimed to investigate the prognostic value of the LUS score in patients with COVID-19.

Method

The LUS protocol consisted of 12 scanning zones and was performed in 280 consecutive patients with COVID-19. The LUS score based on B-lines, lung consolidation and pleural line abnormalities was evaluated.

Results

The median time from admission to LUS examinations was 7 days (interquartile range [IQR] 3-10). Patients in the highest LUS score group were more likely to have a lower lymphocyte percentage (LYM%); higher levels of D-dimer, C-reactive protein, hypersensitive troponin I and creatine kinase muscle-brain; more invasive mechanical ventilation therapy; higher incidence of ARDS; and higher mortality than patients in the lowest LUS score group. After a median follow-up of 14 days [IQR, 10-20 days], 37 patients developed ARDS, and 13 died. Patients with adverse outcomes presented a higher rate of bilateral involvement; more involved zones and B-lines, pleural line abnormalities and consolidation; and a higher LUS score than event-free survivors. The Cox models adding the LUS score as a continuous variable (hazard ratio [HR]: 1.05, 95% confidence intervals [CI] 1.02?~?1.08; P??12 predicted adverse outcomes with a specificity and sensitivity of 90.5% and 91.9%, respectively.

Conclusions

The LUS score devised by our group performs well at predicting adverse outcomes in patients with COVID-19 and is important for risk stratification in COVID-19 patients.

SUBMITTER: Ji L

PROVIDER: S-EPMC7754180 | biostudies-literature | 2020 Dec

REPOSITORIES: biostudies-literature

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Publications

Prognostic value of bedside lung ultrasound score in patients with COVID-19.

Ji Li L Cao Chunyan C Gao Ying Y Zhang Wen W Xie Yuji Y Duan Yilian Y Kong Shuangshuang S You Manjie M Ma Rong R Jiang Lili L Liu Jie J Sun Zhenxing Z Zhang Ziming Z Wang Jing J Yang Yali Y Lv Qing Q Zhang Li L Li Yuman Y Zhang Jinxiang J Xie Mingxing M

Critical care (London, England) 20201222 1

<h4>Background</h4>Bedside lung ultrasound (LUS) has emerged as a useful and non-invasive tool to detect lung involvement and monitor changes in patients with coronavirus disease 2019 (COVID-19). However, the clinical significance of the LUS score in patients with COVID-19 remains unknown. We aimed to investigate the prognostic value of the LUS score in patients with COVID-19.<h4>Method</h4>The LUS protocol consisted of 12 scanning zones and was performed in 280 consecutive patients with COVID-1 ...[more]

PMID: 33353548

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Project description:Background: Lung injury is a common condition among hospitalized patients with coronavirus disease 2019 (COVID-19). However, whether lung ultrasound (LUS) score predicts all-cause mortality in patients with COVID-19 is unknown. The aim of the present study was to explore the predictive value of lung ultrasound score for mortality in patients with COVID-19. Methods: Patients with COVID-19 who underwent lung ultrasound were prospectively enrolled from three hospitals in Wuhan, China between February 2020 and March 2020. Demographic, clinical, and laboratory data were collected from digital patient records. Lung ultrasound scores were analyzed offline by two observers. Primary outcome was in-hospital mortality. Results: Of the 402 patients, 318 (79.1%) had abnormal lung ultrasound. Compared with survivors (n = 360), non-survivors (n = 42) presented with more B2 lines, pleural line abnormalities, pulmonary consolidation, and pleural effusion (all p < 0.05). Moreover, non-survivors had higher global and anterolateral lung ultrasound score than survivors. In the receiver operating characteristic analysis, areas under the curve were 0.936 and 0.913 for global and anterolateral lung ultrasound score, respectively. A cutoff value of 15 for global lung ultrasound score had a sensitivity of 92.9% and specificity of 85.3%, and 9 for anterolateral score had a sensitivity of 88.1% and specificity of 83.3% for prediction of death. Kaplan-Meier analysis showed that both global and anterolateral scores were strong predictors of death (both p < 0.001). Multivariate Cox regression analysis showed that global lung ultrasound score was an independent predictor (hazard ratio, 1.08; 95% confidence interval, 1.01-1.16; p = 0.03) of death together with age, male sex, C-reactive protein, and creatine kinase-myocardial band. Conclusion: Lung ultrasound score as a semiquantitative tool can be easily measured by bedside lung ultrasound. It is a powerful predictor of in-hospital mortality and may play a crucial role in risk stratification of patients with COVID-19.

Project description:BackgroundPatients with coronavirus disease-19 (COVID-19) are susceptible to cardiac complications, and cardiac ultrasound is the preferred noninvasive method for clinical cardiac structure and function assessment.MethodsWe performed a retrospective study of 34 patients with COVID-19 and analyzed their clinical data, biochemistry test results [creatine kinase-MB (CK-MB), cardiac troponin I (cTnI) and C-reactive protein (CRP)], and parameters of cardiac ultrasound [left atrium (LA), left ventricular end-diastolic dimensions (LVDD), right atrium (RA), right ventricle (RV), main pulmonary artery (MPA), left ventricular ejection fraction (LVEF), tricuspid valve (TV), pulmonic valve (PV) and pulmonary artery systolic pressure (PASP)]. We classified the patients based on their clinical symptoms (mild, moderate, severe, and critical groups), and compared the parameters. CK-MB and cardiac ultrasound parameters are presented as mean ± standard deviation and compared using the one-way ANOVA. CTnI is presented as counts (percentages) and compared using the χ2 test, CRP is presented as [M (P25, P75)] [median (interquartile range)] and compared using nonparametric tests (Kruskal-Wallis test).ResultsAs the disease progressed, the parameters of both biochemical blood tests and cardiac ultrasound changed regularly, manifested as enlargement of the LA, LVDD, RA, RV, and MPA and increased PASP, CRP, CK-MB, and cTnI. Of these parameters, CRP, LA, LVDD, MPA, and PASP of the severe group were more notably elevated than in the mild and moderate groups (P<0.05). The critical group more showed markedly increased CK-MB, cTnI, and RA than the other groups (P<0.05), and CRP, LA, LVDD, RV, MPA, and PASP rose more sharply than in the mild and moderate groups (P<0.05).ConclusionsAs COVID-19 progressed, patients developed an enlarged heart with expanded pulmonary arteries and elevated PASP. Bedside ultrasound can be used as a noninvasive assessment of these changes and for guidance of clinical treatment.

Project description:Background and objectivesLung Ultrasound Score (LUS) identifies and monitors pneumonia by assigning increasing scores. However, it does not include parameters, such as inferior vena cava (IVC) diameter and index of collapse, diaphragmatic excursions and search for pleural and pericardial effusions. Therefore, we propose a new improved scoring system, termed "integrated" lung ultrasound score (i-LUS) which incorporates previously mentioned parameters that can help in prediction of disease severity and survival, choice of oxygenation mode/ventilation and assignment to subsequent areas of care in patients with COVID-19 pneumonia.MethodsUpon admission at the sub-intensive section of the emergency medical department (SEMD), 143 consecutively examined COVID-19 patients underwent i-LUS together with all other routine analysis. A database for anamnestic information, laboratory data, gas analysis and i-LUS parameters was created and analyzed.ResultsOf 143 enrolled patients, 59.4% were male (mean age 71 years) and 40.6% female. (mean age 79 years: p = 0.005). Patients that survived at 1 month had i-LUS score of 16, which was lower than that of non-survivors (median 20; p = 0.005). Survivors had a higher PaO2/FiO2 (median 321.5) compared to non-survivors (median 229, p < 0.001). There was a correlation between i-LUS and PaO2/FiO2 ratio (rho:-0.4452; p < 0.001), PaO2/FiO2 and survival status (rho:-0.3452; p < 0.001), as well as i-LUS score and disease outcome (rho:0.24; p = 0.005). In non-survivors, the serum values of different significant COVID indicators were severely expressed. The i-LUS score was higher (median 20) in patients who required non-invasive ventilation (NIV) than in those treated only by oxygen therapy (median 15.42; p = 0.003). The odds ratio for death outcome was 1.08 (confidence interval 1.02-1.15) for each point increased. At 1-month follow-up, 65 patients (45.5%) died and 78 (54.5%) survived. Patients admitted to the high critical ward had higher i-LUS score than those admitted to the low critical one (p < 0.003).Conclusionsi-LUS could be used as a helpful clinical tool for early decision-making in patients with COVID-19 pneumonia.

Dataset Information

Prognostic value of bedside lung ultrasound score in patients with COVID-19.

Background

Method

Results

Conclusions

Publications

Prognostic value of bedside lung ultrasound score in patients with COVID-19.

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