Secco Gianmarco, Delorenzo Marzia, Salinaro Francesco, Zattera Caterina, Barcella Bruno, Resta Flavia, Sabena Anna, Vezzoni Giulia, Bonzano Marco, Briganti Federica, Cappa Giovanni, Zugnoni Francesca, Demitry Lorenzo, Mojoli Francesco, Baldanti Fausto, Bruno Raffaele, Perlini Stefano
Emergency Medicine Unit and Emergency Medicine Postgraduate Training Program, Internal Medicine, Vascular and Metabolic Disease Unit, Department of Internal Medicine, IRCCS Policlinico San Matteo Foundation, University of Pavia, P.Le Golgi, 19, 27100, Pavia, Italy.
Intensive Care Unit, Department of Internal Medicine, IRCCS Policlinico San Matteo Foundation, University of Pavia, Pavia, Italy.
Intern Emerg Med. 2021 Aug;16(5):1317-1327. doi: 10.1007/s11739-020-02620-9. Epub 2021 Mar 1.
Bedside lung ultrasound (LUS) can play a role in the setting of the SarsCoV2 pneumonia pandemic. To evaluate the clinical and LUS features of COVID-19 in the ED and their potential prognostic role, a cohort of laboratory-confirmed COVID-19 patients underwent LUS upon admission in the ED. LUS score was derived from 12 fields. A prevalent LUS pattern was assigned depending on the presence of interstitial syndrome only (Interstitial Pattern), or evidence of subpleural consolidations in at least two fields (Consolidation Pattern). The endpoint was 30-day mortality. The relationship between hemogasanalysis parameters and LUS score was also evaluated. Out of 312 patients, only 36 (11.5%) did not present lung involvment, as defined by LUS score < 1. The majority of patients were admitted either in a general ward (53.8%) or in intensive care unit (9.6%), whereas 106 patients (33.9%) were discharged from the ED. In-hospital mortality was 25.3%, and 30-day survival was 67.6%. A LUS score > 13 had a 77.2% sensitivity and a 71.5% specificity (AUC 0.814; p < 0.001) in predicting mortality. LUS alterations were more frequent (64%) in the posterior lower fields. LUS score was related with P/F (R 0.68; p < 0.0001) and P/F at FiO = 21% (R 0.59; p < 0.0001). The correlation between LUS score and P/F was not influenced by the prevalent ultrasound pattern. LUS represents an effective tool in both defining diagnosis and stratifying prognosis of COVID-19 pneumonia. The correlation between LUS and hemogasanalysis parameters underscores its role in evaluating lung structure and function.
床旁肺部超声（LUS）在新型冠状病毒肺炎大流行背景下可发挥作用。为评估急诊科中新型冠状病毒肺炎（COVID-19）的临床和LUS特征及其潜在的预后作用，一组实验室确诊的COVID-19患者在急诊科入院时接受了LUS检查。LUS评分来自12个区域。根据仅存在间质综合征（间质模式）或至少两个区域存在胸膜下实变的证据（实变模式）来确定主要的LUS模式。终点为30天死亡率。还评估了血气分析参数与LUS评分之间的关系。在312例患者中，只有36例（11.5%）未出现LUS评分<1所定义的肺部受累情况。大多数患者入住普通病房（53.8%）或重症监护病房（9.6%），而106例患者（33.9%）从急诊科出院。住院死亡率为25.3%，30天生存率为67.6%。LUS评分>13在预测死亡率方面的敏感性为77.2%，特异性为71.5%（曲线下面积0.814；p<0.001）。LUS改变在后下区域更常见（64%）。LUS评分与P/F（R=0.68；p<0.0001）以及在FiO₂=21%时的P/F（R=0.59；p<0.0001）相关。LUS评分与P/F之间的相关性不受主要超声模式的影响。LUS是定义COVID-19肺炎诊断和分层预后的有效工具。LUS与血气分析参数之间的相关性突出了其在评估肺结构和功能方面的作用。
