Mafort Thiago Thomaz, Rufino Rogério, da Costa Claudia Henrique, da Cal Mariana Soares, Monnerat Laura Braga, Litrento Patrícia Frascari, Parra Laura Lizeth Zuluaga, Marinho Arthur de Sá Earp de Souza, Lopes Agnaldo José
Department of Pulmonology, Piquet Carneiro Policlinic, State University of Rio de Janeiro, Av. Mal. Rondon, 381, São Francisco Xavier, Rio de Janeiro, 20950-003, Brazil.
Postgraduate Programme in Medical Sciences, School of Medical Sciences, State University of Rio de Janeiro, Av. Prof. Manuel de Abreu, 444, 2° andar, Vila Isabel, Rio de Janeiro, 20550-170, Brazil.
Ultrasound J. 2021 Apr 9;13(1):19. doi: 10.1186/s13089-021-00223-9.
The role of lung ultrasound (LUS) in evaluating the mid- and long-term prognoses of patients with COVID-19 pneumonia is not yet known. The objectives of this study were to evaluate associations between LUS signs at the time of screening and clinical outcomes 1 month after LUS and to assess LUS signs at the time of presentation with known risk factors for COVID-19 pneumonia.
This was a retrospective study of data prospectively collected 1 month after LUS screening of 447 adult patients diagnosed with COVID-19 pneumonia. Sonographic examination was performed in screening tents with the participants seated. The LUS signs (B-lines > 2, coalescent B-lines, and subpleural consolidations) were captured in six areas of each hemithorax and a LUS aeration score was calculated; in addition, the categories of disease probability based on patterns of LUS findings (high-probability, intermediate-probability, alternate, and low-probability patterns) were evaluated. The LUS signs at patients' initial evaluation were related to the following outcomes: symptomatology, the need for hospitalization or invasive mechanical ventilation (IMV), and COVID-19-related death.
According to the evaluations performed 1 month after LUS screening, 36 patients were hospitalised, eight of whom required intensive care unit (ICU) admission and three of whom died. The presence of coalescent B-lines was associated with the need for hospitalization (p = 0.008). The presence of subpleural consolidations was associated with dyspnoea (p < 0.0001), cough (p = 0.003), the need for hospitalization (p < 0.0001), the need for ICU admission (p < 0.0001), and death (p = 0.002). A higher aeration score was associated with dyspnoea (p < 0.0001), the need for hospitalization (p < 0.0001), the need for ICU admission (p < 0.0001), and death (p = 0.003). In addition, patients with a high-probability LUS pattern had a higher aeration score (p < 0.0001) and more dyspnoea (p = 0.024) and more often required hospitalization (p < 0.0001) and ICU admission (p = 0.031).
In patients with COVID-19 pneumonia, LUS signs were related to respiratory symptoms 1 month after LUS screening. Strong relationships were identified between LUS signs and the need for hospitalization and death.
肺超声（LUS）在评估新型冠状病毒肺炎（COVID-19肺炎）患者的中长期预后中的作用尚不清楚。本研究的目的是评估筛查时的LUS征象与LUS检查1个月后的临床结局之间的关联，并评估出现COVID-19肺炎已知危险因素时的LUS征象。
这是一项回顾性研究，对447例确诊为COVID-19肺炎的成年患者进行LUS筛查1个月后前瞻性收集的数据进行分析。超声检查在筛查帐篷中进行，参与者坐着。在每个半侧胸腔的六个区域捕捉LUS征象（B线>2条、融合B线和胸膜下实变），并计算LUS通气评分；此外，根据LUS检查结果模式（高概率、中等概率、交替和低概率模式）评估疾病概率类别。患者初始评估时的LUS征象与以下结局相关：症状、住院或有创机械通气（IMV）需求以及COVID-19相关死亡。
根据LUS筛查1个月后的评估，36例患者住院，其中8例需要入住重症监护病房（ICU），3例死亡。融合B线的出现与住院需求相关（p = 0.008）。胸膜下实变的出现与呼吸困难（p < 0.0001）、咳嗽（p = 0.003）、住院需求（p < 0.0001）、入住ICU需求（p < 0.0001）和死亡（p = 0.002）相关。较高的通气评分与呼吸困难（p < 0.0001）、住院需求（p < 0.0001）、入住ICU需求（p < 0.0001）和死亡（p = 0.003）相关。此外，LUS高概率模式的患者通气评分更高（p < 0.0001），呼吸困难更多（p = 0.024），更常需要住院（p < 0.0001）和入住ICU（p = 0.031）。
在COVID-19肺炎患者中，LUS征象与LUS筛查1个月后的呼吸道症状相关。LUS征象与住院需求和死亡之间存在密切关系。
