Department of Internal Medicine, Luigi Sacco Hospital, ASST-FBF-Sacco, Milan, Italy.
Department of Internal Medicine, Luigi Sacco Hospital, ASST-FBF-Sacco, Milan, Italy.
Eur J Intern Med. 2021 Mar;85:34-40. doi: 10.1016/j.ejim.2020.12.012. Epub 2021 Jan 2.
High diagnostic accuracy for pneumonia, absence of radiation exposure and repeatability are intrinsic features of lung ultrasonography making it an attractive tool in the assessment of patients with COVID-19 pneumonia. The aim of our prospective, observational study was to detect COVID-19-associated sonographic features and assess the potential value of LUS in predicting adverse events.
From March 12th to April 20th 2020 patients admitted to two medium-intensive wards with a discharge diagnosis of COVID-19 pneumonia were enrolled and underwent lung ultrasonography. The prognostic value of several ultrasonographic scores at admission and after 72 hours from the first examination (the total score, the anterolateral score, the number of positive region and the presence of consolidation) were analysed with logistic regression along with other potential prognostic factors. The primary outcome was a composite of death and transfer to Intensive Care Unit (ICU), while the secondary was continuous positive airways pressure (CPAP) support.
190 patients were enrolled in the study. The primary outcome was seen in 25 patients (13%), the secondary outcome in 36 (22%). At multivariate regression no sonographic score at admission was independently correlated with the primary outcome while the total score, the anterolateral score, the number of positive regions were associated with CPAP support. When considering the subgroup of patients undergoing lung ultrasonography after 72 hours (128 patients) the total score was independently associated with both the primary and secondary outcome.
Lung ultrasonography can be a promising prognostic tool in patients admitted to non-ICU units for COVID-19 pneumonia.
肺部超声具有诊断准确率高、无辐射暴露和可重复性等优点，使其成为评估 COVID-19 肺炎患者的一种有吸引力的工具。本前瞻性观察研究旨在检测 COVID-19 相关的超声特征，并评估 LUS 在预测不良事件中的潜在价值。
从 2020 年 3 月 12 日至 4 月 20 日，我们招募了入住两家中型强化病房并被诊断为 COVID-19 肺炎的患者，并对其进行了肺部超声检查。通过逻辑回归分析了入院时和首次检查后 72 小时的几个超声评分（总评分、前外侧评分、阳性区域数量和实变存在）以及其他潜在的预后因素的预后价值。主要结果是死亡和转入重症监护病房（ICU）的复合结果，次要结果是持续气道正压通气（CPAP）支持。
共有 190 名患者入组研究。25 名患者（13%）出现主要结局，36 名患者（22%）出现次要结局。多变量回归分析显示，入院时的超声评分与主要结局无独立相关性，而总评分、前外侧评分和阳性区域数量与 CPAP 支持相关。当考虑在 72 小时后进行肺部超声检查的患者亚组（128 名患者）时，总评分与主要和次要结局均独立相关。
肺部超声在非 ICU 病房的 COVID-19 肺炎患者中可能是一种有前途的预后工具。
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