Gil-Rodríguez Jaime, Martos-Ruiz Michel, Benavente-Fernández Alberto, Aranda-Laserna Pablo, Montero-Alonso Miguel Ángel, Peregrina-Rivas José-Antonio, Fernández-Reyes Daniel, Martínez de Victoria-Carazo Javier, Guirao-Arrabal Emilio, Hernández-Quero José
Internal Medicine Unit, San Cecilio University Hospital, Avenida del Conocimiento s/n, 18016 Granada, Spain.
Department of Statistics and Operational Research, University of Granada, Avenida de la Investigación n° 11, 18071 Granada, Spain.
Med Clin (Engl Ed). 2023 Jun 23;160(12):531-539. doi: 10.1016/j.medcle.2023.01.023. Epub 2023 Jun 16.
Our purpose was to establish different cut-off points based on the lung ultrasound score (LUS) to classify COVID-19 pneumonia severity.
Initially, we conducted a systematic review among previously proposed LUS cut-off points. Then, these results were validated by a single-centre prospective cohort study of adult patients with confirmed SARS-CoV-2 infection. Studied variables were poor outcome (ventilation support, intensive care unit admission or 28-days mortality) and 28-days mortality.
From 510 articles, 11 articles were included. Among the cut-off points proposed in the articles included, only the LUS > 15 cut-off point could be validated for its original endpoint, demonstrating also the strongest relation with poor outcome (odds ratio [OR] = 3.636, confidence interval [CI] 1.411-9.374). Regarding our cohort, 127 patients were admitted. In these patients, LUS was statistically associated with poor outcome (OR = 1.303, CI 1.137-1.493), and with 28-days mortality (OR = 1.024, CI 1.006-1.042). LUS > 15 showed the best diagnostic performance when choosing a single cut-off point in our cohort (area under the curve 0.650). LUS ≤ 7 showed high sensitivity to rule out poor outcome (0.89, CI 0.695-0.955), while LUS > 20 revealed high specificity to predict poor outcome (0.86, CI 0.776-0.917).
LUS is a good predictor of poor outcome and 28-days mortality in COVID-19. LUS ≤ 7 cut-off point is associated with mild pneumonia, LUS 8-20 with moderate pneumonia and ≥20 with severe pneumonia. If a single cut-off point were used, LUS > 15 would be the point which better discriminates mild from severe disease.
我们的目的是基于肺部超声评分（LUS）建立不同的截断点，以对新型冠状病毒肺炎（COVID-19）的严重程度进行分类。
首先，我们对先前提出的LUS截断点进行了系统评价。然后，通过一项针对确诊感染严重急性呼吸综合征冠状病毒2（SARS-CoV-2）的成年患者的单中心前瞻性队列研究对这些结果进行验证。研究变量为不良结局（通气支持、入住重症监护病房或28天死亡率）和28天死亡率。
从510篇文章中，纳入了11篇。在纳入文章中提出的截断点中，只有LUS>15这个截断点对于其原始终点能够得到验证，同时也显示出与不良结局的最强关联（比值比[OR]=3.636，置信区间[CI]1.411-9.374）。对于我们的队列，共纳入127例患者。在这些患者中，LUS与不良结局在统计学上相关（OR=1.303，CI 1.137-1.493），并且与28天死亡率相关（OR=1.024，CI 1.006-1.042）。在我们的队列中选择单个截断点时，LUS>15显示出最佳的诊断性能（曲线下面积为0.650）。LUS≤7对排除不良结局具有高敏感性（0.89，CI 0.695-0.955），而LUS>20对预测不良结局具有高特异性（0.86，CI 0.776-0.917）。
LUS是COVID-19不良结局和28天死亡率的良好预测指标。LUS≤7的截断点与轻度肺炎相关，LUS 8-20与中度肺炎相关，≥20与重度肺炎相关。如果使用单个截断点，LUS>15将是区分轻、重症疾病的最佳点。
