Zhang Lei, Yu Wanjun, Zhou Chengjie, Chen Guozhong
Department of Intensive Care Unit, Yinzhou Hospital Affiliated to Medical School of Ningbo University (Ningbo Yinzhou People's Hospital), Ningbo 315040, Zhejiang, China.
Department of Respiratory and Critical Care Medicine, Yinzhou Hospital Affiliated to Medical School of Ningbo University (Ningbo Yinzhou People's Hospital), Ningbo 315040, Zhejiang, China. Corresponding author: Chen Guozhong, Email:
Zhonghua Wei Zhong Bing Ji Jiu Yi Xue. 2020 May;32(5):585-589. doi: 10.3760/cma.j.cn121430-20200102-00088.
To evaluate the value of lung ultrasonography score (LUS) on assessing extravascular lung water (EVLW) and prognosis in patients with acute respiratory distress syndrome (ARDS).
The clinical data of 46 patients meeting ARDS Berlin definition admitted to intensive care unit (ICU) of Ningbo Yinzhou People's Hospital from July 2016 to December 2019 were retrospectively collected. The general data, vital signs, blood lactic acid (Lac), oxygenation index (OI), LUS, extravascular lung water index (EVLWI), sequential organ failure assessment (SOFA) score, clinical pulmonary infection score (CPIS) and the length of ICU stay were collected. According to the prognosis of patients during ICU treatment, the patients were divided into survival group and non-survival group, and the clinical characteristics between the two groups were compared. The correlation between LUS and OI, EVLWI, SOFA, and CPIS were analyzed by Pearson correlation analysis. Receiver operator characteristic (ROC) curve was plotted to determine the prognostic value of LUS for ARDS patients during ICU treatment.
Forty-six patients were enrolled in the analysis, of whom 32 patients survived (69.6%), and 14 patients died (30.4%) during ICU treatment. There was no significant difference in gender, age, left ventricular ejection fraction (LVEF) or heart rate (HR) between the two groups. Compared with the survival group, the mean arterial pressure (MAP) and OI in the non-survival group were significantly lowered [MAP (mmHg, 1 mmHg = 0.133 kPa): 57.48±33.34 vs. 85.45±19.56, OI (mmHg): 74.50±18.40 vs. 233.06±28.28, both P < 0.05], while Lac, LUS, EVLWI, SOFA and CPIS were significantly increased [Lac (mmol/L): 6.78±2.56 vs. 2.21±1.42, LUS score: 23.57±2.03 vs. 15.58±2.24, EVLWI (mL/kg): 22.93±2.56 vs. 12.96±2.18, SOFA score: 20.21±3.35 vs. 12.43±2.97, CPIS score: 8.07±1.38 vs. 4.59±1.04, all P < 0.01], and the length of ICU stay was significantly shortened (days: 9.33±3.28 vs. 16.89±4.12, P < 0.05]. Pearson correlation analysis showed that a significant negative linear correlation was found between LUS and OI (r = -0.823, P < 0.01), and positive linear correlations were found between LUS and EVLWI, SOFA, CPIS (r values were 0.745, 0.614, 0.757, respectively, all P < 0.01). ROC curve analysis showed that both LUS and EVLWI could predict the prognosis of ARDS patients during ICU treatment, and the areas under ROC curve (AUC) of LUS and EVLWI were 0.936 and 0.991, respectively. When the cut-off of LUS score was 20.5, the sensitivity and specificity were 85.7% and 81.2% respectively.
LUS score has a good correlation with EVLWI monitored by pulse index continuous cardiac output (PiCCO), which can reflect lung water content. LUS score can be used as an early prognostic indicator for ARDS patients.
评估肺部超声评分（LUS）对急性呼吸窘迫综合征（ARDS）患者血管外肺水（EVLW）及预后的评估价值。
回顾性收集2016年7月至2019年12月在宁波市鄞州人民医院重症监护病房（ICU）收治的46例符合ARDS柏林定义患者的临床资料。收集患者的一般资料、生命体征、血乳酸（Lac）、氧合指数（OI）、LUS、血管外肺水指数（EVLWI）、序贯器官衰竭评估（SOFA）评分、临床肺部感染评分（CPIS）及ICU住院时间。根据患者在ICU治疗期间的预后情况，将患者分为存活组和非存活组，比较两组间的临床特征。采用Pearson相关分析LUS与OI、EVLWI、SOFA及CPIS的相关性。绘制受试者工作特征（ROC）曲线，以确定LUS对ARDS患者在ICU治疗期间的预后价值。
46例患者纳入分析，其中32例患者存活（69.6%），14例患者在ICU治疗期间死亡（30.4%）。两组患者在性别、年龄、左心室射血分数（LVEF）或心率（HR）方面无显著差异。与存活组相比，非存活组的平均动脉压（MAP）和OI显著降低[MAP（mmHg，1 mmHg = 0.133 kPa）：57.48±33.34 vs. 85.45±19.56，OI（mmHg）：74.50±18.40 vs. 233.06±28.28，均P < 0.05]，而Lac、LUS、EVLWI、SOFA及CPIS显著升高[Lac（mmol/L）：6.78±2.56 vs. 2.21±1.42，LUS评分：23.57±2.03 vs. 15.58±2.24，EVLWI（mL/kg）：22.93±2.56 vs. 12.96±2.18，SOFA评分：20.21±3.35 vs. 12.43±2.97，CPIS评分：8.07±1.38 vs. 4.59±1.04，均P < 0.01]，且ICU住院时间显著缩短（天：9.33±3.28 vs. 16.89±4.12，P < 0.05）。Pearson相关分析显示，LUS与OI之间存在显著负线性相关（r = -0.823，P < 0.01），LUS与EVLWI、SOFA、CPIS之间存在正线性相关（r值分别为0.745、0.614、0.757，均P < 0.01）。ROC曲线分析显示，LUS和EVLWI均可预测ARDS患者在ICU治疗期间的预后，LUS和EVLWI的ROC曲线下面积（AUC）分别为0.936和0.991。当LUS评分的截断值为20.5时，敏感性和特异性分别为85.7%和81.2%。
LUS评分与脉搏指示连续心输出量（PiCCO）监测的EVLWI具有良好的相关性，能够反映肺水含量。LUS评分可作为ARDS患者的早期预后指标。
