COVID-19 肺炎的风险分层 - 肺超声的作用。

Risk Stratification in COVID-19 Pneumonia - Determining the Role of Lung Ultrasound.

机构信息

Emergency Department, Niguarda Hospital, Milano, Italy.

Emergency Department, ASST Lodi, Italy.

出版信息

Ultraschall Med. 2022 Apr;43(2):168-176. doi: 10.1055/a-1344-4715. Epub 2021 Feb 18.

DOI:10.1055/a-1344-4715

PMID:33601427

Abstract

UNLABELLED

LUS patterns of COVID-19 pneumonia have been described and shown to be characteristic. The aim of the study was to predict the prognosis of patients with COVID-19 pneumonia, using a score based on LUS findings.

MATERIALS AND METHODS

An observational, retrospective study was conducted on patients admitted to Niguarda hospital with a diagnosis of COVID-19 pneumonia during the period of a month, from March 2 to April 3 2020. Demographics, clinical, laboratory, and radiological findings were collected. LUS was performed in all patients. The chest was divided into 12 areas. The LUS report was drafted using a score from 0 to 3 with 0 corresponding to A pattern, 1 corresponding to well separated vertical artifacts (B lines), 2 corresponding to white lung and small consolidations, 3 corresponding to wide consolidations. The total score results from the sum of the scores for each area. The primary outcome was endotracheal intubation, no active further management, or death. The secondary outcome was discharge from the emergency room (ER).

RESULTS

255 patients were enrolled. 93.7 % had a positive LUS. ETI was performed in 43 patients, and 24 received a DNI order. The general mortality rate was 15.7 %. Male sex (OR 3.04, p = 0.014), cardiovascular disease and hypertension (OR 2.75, p = 0.006), P/F (OR 0.99, p < 0.001) and an LUS score > 20 (OR 2.52, p = 0.046) were independent risk factors associated with the primary outcome. Receiver operating characteristic (ROC) curve analysis for an LUS score > 20 was performed with an AUC of 0.837. Independent risk factors associated with the secondary outcome were age (OR 0.96, p = 0.073), BMI (OR 0.87, p = 0,13), P/F (OR 1.03, p < 0.001), and LUS score < 10 (OR 20.9, p = 0.006). ROC curve analysis was performed using an LUS score < 10 with an AUC 0.967.

CONCLUSION

The extent of lung abnormalities evaluated by LUS score is a predictor of a worse outcome, ETI, or death. Moreover, the LUS score could be an additional tool for the safe discharge of patient from the ER.

摘要

目的

使用基于 LUS 发现的评分来预测 COVID-19 肺炎患者的预后。

材料和方法

对 2020 年 3 月 2 日至 4 月 3 日期间因 COVID-19 肺炎入住 Niguarda 医院的患者进行了一项观察性、回顾性研究。收集了人口统计学、临床、实验室和影像学结果。对所有患者进行 LUS 检查。胸部被分为 12 个区域。使用 0 到 3 的评分制定 LUS 报告，其中 0 对应 A 模式，1 对应垂直分离良好的伪影（B 线），2 对应白色肺和小实变，3 对应广泛实变。总评分是每个区域评分的总和。主要结局是气管插管、无积极进一步治疗或死亡。次要结局是从急诊室（ER）出院。

结果

共纳入 255 例患者。93.7%的患者 LUS 阳性。43 例患者进行了 ETI，24 例患者接受了 DNI 医嘱。总死亡率为 15.7%。男性（OR 3.04，p=0.014）、心血管疾病和高血压（OR 2.75，p=0.006）、P/F（OR 0.99，p<0.001）和 LUS 评分>20（OR 2.52，p=0.046）是与主要结局相关的独立危险因素。对 LUS 评分>20 进行了受试者工作特征（ROC）曲线分析，AUC 为 0.837。与次要结局相关的独立危险因素是年龄（OR 0.96，p=0.073）、BMI（OR 0.87，p=0.13）、P/F（OR 1.03，p<0.001）和 LUS 评分<10（OR 20.9，p=0.006）。对 LUS 评分<10 进行了 ROC 曲线分析，AUC 为 0.967。