Department of Ultrasound, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, 1277# Jiefang Ave, Wuhan, 430022, China.
Hubei Province Key Laboratory of Molecular Imaging, 1277# Jiefang Ave, Wuhan, 430022, China.
Crit Care. 2020 Dec 22;24(1):700. doi: 10.1186/s13054-020-03416-1.
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.
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.
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 < 0.001; Akaike information criterion [AIC] = 272; C-index = 0.903) or as a categorical variable (HR 10.76, 95% CI 2.75 ~ 42.05; P = 0.001; AIC = 272; C-index = 0.902) were found to predict poor outcomes more accurately than the basic model (AIC = 286; C-index = 0.866). An LUS score cut-off > 12 predicted adverse outcomes with a specificity and sensitivity of 90.5% and 91.9%, respectively.
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.
床边肺部超声（LUS）已成为一种有用的非侵入性工具，可用于检测 2019 年冠状病毒病（COVID-19）患者的肺部受累情况并监测其变化。然而，COVID-19 患者的 LUS 评分的临床意义尚不清楚。我们旨在探讨 LUS 评分在 COVID-19 患者中的预后价值。
LUS 方案包括 12 个扫描区，对 280 例连续 COVID-19 患者进行了评估。评估了基于 B 线、肺实变和胸膜线异常的 LUS 评分。
从入院到 LUS 检查的中位时间为 7 天（四分位距 [IQR] 3-10）。LUS 评分最高组的患者淋巴细胞百分比（LYM%）较低；D-二聚体、C 反应蛋白、高敏肌钙蛋白 I 和肌酸激酶脑肌同工酶水平较高；更需要有创机械通气治疗；急性呼吸窘迫综合征（ARDS）发生率较高；死亡率也高于 LUS 评分最低组。中位随访 14 天[IQR，10-20 天]后，37 例患者发生 ARDS，13 例死亡。不良结局患者双侧受累比例较高；受累区域和 B 线、胸膜线异常和实变的区域和 B 线更多；LUS 评分也高于无事件幸存者。Cox 模型将 LUS 评分作为连续变量（风险比 [HR]：1.05，95%置信区间 [CI] 1.021.08；P<0.001；Akaike 信息准则 [AIC]为 272；C 指数为 0.903）或作为分类变量（HR 10.76，95%CI 2.7542.05；P=0.001；AIC 为 272；C 指数为 0.902）均能更准确地预测不良结局，优于基本模型（AIC 为 286；C 指数为 0.866）。LUS 评分>12 分可预测不良结局，其特异性和敏感性分别为 90.5%和 91.9%。
本研究团队制定的 LUS 评分能很好地预测 COVID-19 患者的不良结局，对于 COVID-19 患者的风险分层具有重要意义。
