Tel Aviv Sourasky Medical Center and Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel.
Department of Cardiology, Tel Aviv Medical Center, Weizmann 6, 6423919, Tel Aviv, Israel.
Intensive Care Med. 2020 Oct;46(10):1873-1883. doi: 10.1007/s00134-020-06212-1. Epub 2020 Aug 28.
Information regarding the use of lung ultrasound (LUS) in patients with Coronavirus disease 2019 (COVID-19) is quickly accumulating, but its use for risk stratification and outcome prediction has yet to be described. We performed the first systematic and comprehensive LUS evaluation of consecutive patients hospitalized with COVID-19 infection, in order to describe LUS findings and their association with clinical course and outcome.
Between 21/03/2020 and 04/05/2020, 120 consecutive patients admitted to the Tel Aviv Medical Center due to COVID-19, underwent complete LUS within 24 h of admission. A second exam was performed in case of clinical deterioration. LUS score of 0 (best)-36 (worst) was assigned to each patient. LUS findings were compared with clinical data.
The median baseline total LUS score was 15, IQR [7-20]. Baseline LUS score was 0-18 in 80 (67%) patients, and 19-36 in 40 (33%) patients. The majority had patchy pleural thickening (n = 100; 83%), or patchy subpleural consolidations (n = 93; 78%) in at least one zone. The prevalence of pleural thickening, subpleural consolidations and the total LUS score were all correlated with severity of illness on admission. Clinical deterioration was associated with increased follow-up LUS scores (p = 0.0009), mostly due to loss of aeration in anterior lung segments. The optimal cutoff point for LUS score was 18 (sensitivity = 62%, specificity = 74%). Both mortality and need for invasive mechanical ventilation were increased with baseline LUS score > 18 compared to baseline LUS score 0-18. Unadjusted hazard ratio of death for LUS score was 1.08 per point [1.02-1.16], p = 0.008; Unadjusted hazard ratio of the composite endpoint (death or need for invasive mechanical ventilation) for LUS score was 1.12 per point [1.05-1.2], p = 0.0008.
Hospitalized patients with COVID-19, at all clinical grades, present with pathological LUS findings. Baseline LUS score strongly correlates with the eventual need for invasive mechanical ventilation and is a strong predictor of mortality. Routine use of LUS may guide patients' management strategies, as well as resource allocation in case of surge capacity.
有关 2019 年冠状病毒病（COVID-19）患者使用肺部超声（LUS）的信息正在迅速积累，但尚未描述其用于风险分层和预后预测的用途。我们对因 COVID-19 感染而住院的连续患者进行了首次系统和全面的 LUS 评估，以便描述 LUS 结果及其与临床过程和结局的关系。
2020 年 3 月 21 日至 5 月 4 日期间，因 COVID-19 入住特拉维夫医疗中心的 120 例连续患者在入院后 24 小时内接受了完整的 LUS 检查。如果临床病情恶化，则进行第二次检查。每位患者的 LUS 评分被分配为 0（最佳）-36（最差）。将 LUS 结果与临床数据进行比较。
中位基线总 LUS 评分为 15，IQR [7-20]。80%（67%）的患者基线 LUS 评分为 0-18，33%（33%）的患者基线 LUS 评分为 19-36。大多数患者至少在一个区域存在斑片状胸膜增厚（n=100；83%）或斑片状胸膜下实变（n=93；78%）。胸膜增厚、胸膜下实变和总 LUS 评分的发生率均与入院时疾病严重程度相关。与随访 LUS 评分增加相关的是临床恶化（p=0.0009），这主要是由于前肺段通气丧失所致。LUS 评分的最佳截断点为 18（灵敏度=62%，特异性=74%）。与基线 LUS 评分为 0-18 相比，基线 LUS 评分为>18 与死亡率和需要有创机械通气增加相关。LUS 评分每增加 1 分，死亡的未调整风险比为 1.08 [1.02-1.16]，p=0.008；LUS 评分每增加 1 分，死亡或需要有创机械通气的复合终点的未调整风险比为 1.12 [1.05-1.2]，p=0.0008。
所有临床分级的 COVID-19 住院患者均存在病理性 LUS 表现。基线 LUS 评分与最终需要有创机械通气密切相关，是死亡率的有力预测指标。常规使用 LUS 可能指导患者的管理策略，并在出现能力过剩时分配资源。
