Lugarà Marina, Tamburrini Stefania, Coppola Maria Gabriella, Oliva Gabriella, Fiorini Valeria, Catalano Marco, Carbone Roberto, Saturnino Pietro Paolo, Rosano Nicola, Pesce Antonella, Galiero Raffaele, Ferrara Roberta, Iannuzzi Michele, Vincenzo D'Agostino, Negro Alberto, Somma Francesco, Fasano Fabrizio, Perrella Alessandro, Vitiello Giuseppe, Sasso Ferdinando Carlo, Soldati Gino, Rinaldi Luca
U.O.C. Internal Medicine, ASL Center Naples 1, P.O. Ospedale del Mare, 80147 Naples, Italy.
U.O.C. Radiology, ASL Center Naples 1, P.O. Ospedale del Mare, 80147 Naples, Italy.
Diagnostics (Basel). 2022 Jul 31;12(8):1856. doi: 10.3390/diagnostics12081856.
Purpose: We aimed to assess the role of lung ultrasound (LUS) in the diagnosis and prognosis of SARS-CoV-2 pneumonia, by comparing it with High Resolution Computed Tomography (HRCT). Patients and methods: All consecutive patients with laboratory-confirmed SARS-CoV-2 infection and hospitalized in COVID Centers were enrolled. LUS and HRCT were carried out on all patients by expert operators within 48−72 h of admission. A four-level scoring system computed in 12 regions of the chest was used to categorize the ultrasound imaging, from 0 (absence of visible alterations with ultrasound) to 3 (large consolidation and cobbled pleural line). Likewise, a semi-quantitative scoring system was used for HRCT to estimate pulmonary involvement, from 0 (no involvement) to 5 (>75% involvement for each lobe). The total CT score was the sum of the individual lobar scores and ranged from 0 to 25. LUS scans were evaluated according to a dedicated scoring system. CT scans were assessed for typical findings of COVID-19 pneumonia (bilateral, multi-lobar lung infiltration, posterior peripheral ground glass opacities). Oxygen requirement and mortality were also recorded. Results: Ninety-nine patients were included in the study (male 68.7%, median age 71). 40.4% of patients required a Venturi mask and 25.3% required non-invasive ventilation (C-PAP/Bi-level). The overall mortality rate was 21.2% (median hospitalization 30 days). The median ultrasound thoracic score was 28 (IQR 20−36). For the CT evaluation, the mean score was 12.63 (SD 5.72), with most of the patients having LUS scores of 2 (59.6%). The bivariate correlation analysis displayed statistically significant and high positive correlations between both the CT and composite LUS scores and ventilation, lactates, COVID-19 phenotype, tachycardia, dyspnea, and mortality. Moreover, the most relevant and clinically important inverse proportionality in terms of P/F, i.e., a decrease in P/F levels, was indicative of higher LUS/CT scores. Inverse proportionality P/F levels and LUS and TC scores were evaluated by univariate analysis, with a P/F−TC score correlation coefficient of −0.762, p < 0.001, and a P/F−LUS score correlation coefficient of −0.689, p < 0.001. Conclusions: LUS and HRCT show a synergistic role in the diagnosis and disease severity evaluation of COVID-19.
通过与高分辨率计算机断层扫描（HRCT）比较，评估肺部超声（LUS）在新型冠状病毒肺炎诊断和预后中的作用。患者与方法：纳入所有在新冠治疗中心住院且实验室确诊新型冠状病毒感染的连续患者。在入院48 - 72小时内，由专业操作人员对所有患者进行LUS和HRCT检查。采用在胸部12个区域计算的四级评分系统对超声图像进行分类，从0分（超声未见明显改变）到3分（大片实变及锯齿状胸膜线）。同样，采用半定量评分系统对HRCT进行评估以估计肺部受累情况，从0分（无受累）到5分（每个肺叶受累>75%）。CT总评分是各肺叶评分之和，范围为0至25分。LUS扫描根据专用评分系统进行评估。评估CT扫描是否有新冠肺炎的典型表现（双侧、多肺叶肺部浸润、外周后侧磨玻璃影）。还记录了氧需求和死亡率。结果：99例患者纳入研究（男性占68.7%，中位年龄71岁）。40.4%的患者需要文丘里面罩，25.3%的患者需要无创通气（持续气道正压通气/双水平气道正压通气）。总体死亡率为21.2%（中位住院时间30天）。超声胸部中位评分为28分（四分位间距20 - 36）。对于CT评估，平均评分为12.63分（标准差5.72），大多数患者LUS评分为2分（59.6%）。双变量相关分析显示，CT和综合LUS评分与通气、乳酸、新冠肺炎表型、心动过速、呼吸困难和死亡率之间存在统计学显著且高度正相关。此外，就氧合指数（P/F）而言，最相关且临床上重要的反比例关系，即P/F水平降低，表明LUS/CT评分较高。通过单变量分析评估P/F水平与LUS和CT评分的反比例关系，P/F - CT评分相关系数为 - 0.762，p < 0.001，P/F - LUS评分相关系数为 - 0.689，p < 0.001。结论：LUS和HRCT在新冠肺炎的诊断和疾病严重程度评估中显示出协同作用。
