Department of Internal Medicine, Fondazione Istituto di Ricovero e Cura a Carattere Scientifico, Policlinico San Matteo, University of Pavia, Pavia, Italy.
Diagnostic and Interventional Ultrasound Unit, Valle del Serchio General Hospital, Lucca, Italy.
J Ultrasound Med. 2021 Aug;40(8):1627-1635. doi: 10.1002/jum.15548. Epub 2020 Nov 6.
Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection can generate severe pneumonia associated with high mortality. A bedside lung ultrasound (LUS) examination has been shown to have a potential role in this setting. The purpose of this study was to evaluate the potential prognostic value of a new LUS protocol (evaluation of 14 anatomic landmarks, with graded scores of 0-3) in patients with SARS-CoV-2 pneumonia and the association of LUS patterns with clinical or laboratory findings.
A cohort of 52 consecutive patients with laboratory-confirmed SARS-CoV-2 underwent LUS examinations on admission in an internal medicine ward and before their discharge. A total LUS score as the sum of the scores at each explored area was computed. We investigated the association between the LUS score and clinical worsening, defined as a combination of high-flow oxygen support, intensive care unit admission, or 30-day mortality as the primary end point.
Twenty (39%) patients showed a worse outcome during the observation period; the mean LUS scores ± SDs were 20.4 ± 8.5 and 29.2 ± 7.3 in patients without and with worsening, respectively (P < .001). In a multivariable analysis, adjusted for comorbidities (>2), age (>65 years), sex (male), and body mass index (≥25 kg/m ), the association between the LUS score and worsening (odds ratio, 1.17; 95% confidence interval, 1.05 to 1.29; P = .003) was confirmed, with good discrimination of the model (area under the receiver operating characteristic curve, 0.82). A median LUS score higher than 24 was associated with an almost 6-fold increase in the odds of worsening (odds ratio, 5.67; 95% confidence interval, 1.29 to 24.8; P = .021).
Lung ultrasound can represent an effective tool for monitoring and stratifying the prognosis of patients with SARS-CoV-2 pulmonary involvement.
严重急性呼吸综合征冠状病毒 2（SARS-CoV-2）感染可引发与高死亡率相关的严重肺炎。床边肺部超声（LUS）检查已显示出在这种情况下具有潜在作用。本研究的目的是评估新的 LUS 方案（评估 14 个解剖标志，评分 0-3 级）在 SARS-CoV-2 肺炎患者中的潜在预后价值，以及 LUS 模式与临床或实验室发现的关联。
对 52 例经实验室确诊的 SARS-CoV-2 连续患者在内科病房入院时和出院前进行了 LUS 检查。计算每个探索区域得分之和的总 LUS 评分。我们研究了 LUS 评分与临床恶化之间的关联，临床恶化定义为高流量氧气支持、重症监护病房入院或 30 天死亡率的组合作为主要终点。
在观察期间，有 20 例（39%）患者的预后恶化；无恶化患者的平均 LUS 评分±SD 分别为 20.4±8.5 和 29.2±7.3（P<.001）。在多变量分析中，调整了合并症（>2）、年龄（>65 岁）、性别（男性）和体重指数（≥25kg/m2）后，LUS 评分与恶化之间的关联（比值比，1.17；95%置信区间，1.05 至 1.29；P=0.003）得到了确认，该模型的区分度良好（受试者工作特征曲线下面积，0.82）。中位数高于 24 的 LUS 评分与恶化的几率几乎增加 6 倍（比值比，5.67；95%置信区间，1.29 至 24.8；P=0.021）。
肺部超声可以成为监测和分层 SARS-CoV-2 肺部受累患者预后的有效工具。
