与 COVID-19 相关的急性呼吸窘迫综合征、重症监护病房入院和全因死亡率的肺部超声表现。
Lung Ultrasound Findings Associated With COVID-19 ARDS, ICU Admission, and All-Cause Mortality.
机构信息
Cardiovascular Non-Invasive Imaging Research Laboratory, Department of Cardiology, Herlev and Gentofte Hospital, University of Copenhagen, Copenhagen, Denmark.
Cardiovascular Division, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts.
出版信息
Respir Care. 2022 Jan;67(1):66-75. doi: 10.4187/respcare.09108. Epub 2021 Nov 23.
BACKGROUND
As lung ultrasound (LUS) has emerged as a diagnostic tool in patients with COVID-19, we sought to investigate the association between LUS findings and the composite in-hospital outcome of ARDS incidence, ICU admission, and all-cause mortality.
METHODS
In this prospective, multi-center, observational study, adults with laboratory-confirmed SARS-CoV-2 infection were enrolled from non-ICU in-patient units. Subjects underwent an LUS evaluating a total of 8 zones. Images were analyzed off-line, blinded to clinical variables and outcomes. A LUS score was developed to integrate LUS findings: ≥ 3 B-lines corresponded to a score of 1, confluent B-lines to a score of 2, and subpleural or lobar consolidation to a score of 3. The total LUS score ranged from 0-24 per subject.
RESULTS
Among 215 enrolled subjects, 168 with LUS data and no current signs of ARDS or ICU admission (mean age 59 y, 56% male) were included. One hundred thirty-six (81%) subjects had pathologic LUS findings in ≥ 1 zone (≥ 3 B-lines, confluent B-lines, or consolidations). Markers of disease severity at baseline were higher in subjects with the composite outcome ( 31, 18%), including higher median C-reactive protein (90 mg/L vs 55, < .001) and procalcitonin levels (0.35 μg/L vs 0.13, = .033) and higher supplemental oxygen requirements (median 4 L/min vs 2, = .001). However, LUS findings and score did not differ significantly between subjects with the composite outcome and those without, and were not associated with outcomes in unadjusted and adjusted logistic regression analyses.
CONCLUSIONS
Pathologic findings on LUS were common a median of 3 d after admission in this cohort of non-ICU hospitalized subjects with COVID-19 and did not differ among subjects who experienced the composite outcome of incident ARDS, ICU admission, and all-cause mortality compared to subjects who did not. These findings should be confirmed in future investigations. The study is registered at Clinicaltrials.gov (NCT04377035).
背景
由于肺部超声（LUS）已成为 COVID-19 患者的一种诊断工具，我们试图研究 LUS 结果与 ARDS 发生率、入住 ICU 和全因死亡率的综合院内结局之间的关联。
方法
在这项前瞻性、多中心、观察性研究中，从非 ICU 住院患者中招募了经实验室证实的 SARS-CoV-2 感染成人。受试者接受了总共 8 个区域的 LUS 评估。对图像进行离线分析，与临床变量和结果无关。开发了 LUS 评分来整合 LUS 结果：≥ 3 条 B 线对应评分 1，融合 B 线对应评分 2，以及胸膜下或肺叶实变对应评分 3。每位受试者的总 LUS 评分范围为 0-24。
结果
在 215 名入组受试者中，有 168 名受试者具有 LUS 数据且无当前 ARDS 或 ICU 入院迹象（平均年龄 59 岁，56%为男性）被纳入。136 名（81%）受试者的≥ 1 个区域存在病变 LUS 表现（≥ 3 条 B 线、融合 B 线或实变）。基线时疾病严重程度的标志物在复合结局（31%，18%）的受试者中更高，包括更高的中位 C 反应蛋白（90 mg/L 比 55， <.001）和降钙素水平（0.35 μg/L 比 0.13， <.033）和更高的补充氧气需求（中位数 4 L/min 比 2， <.001）。然而，复合结局组与无复合结局组之间的 LUS 结果和评分没有显著差异，在未经调整和调整后的逻辑回归分析中，它们与结局无关。
结论
在 COVID-19 非 ICU 住院患者中，中位数为入院后 3 天，LUS 上的病变表现很常见，与未发生 ARDS、入住 ICU 和全因死亡率的复合结局的患者相比，发生该复合结局的患者并无差异。这些发现应在未来的研究中得到证实。该研究在 Clinicaltrials.gov（NCT04377035）注册。
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