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早期肺部超声评分测量在确定COVID-19呼吸衰竭重症监护病房患者预后中的作用。

The role of early lung ultrasound score measurement in determining prognosis in COVID-19 ICU patients with respiratory failure.

作者信息

Bayrakçi Sinem, Ateş Ayhan Nazire, Firat Ahmet, Bulut Yurdaer, Seydaoğlu Gülşah, Karakoç Emre, Baydar Toprak Oya, Özyilmaz Ezgi

机构信息

Department of ICU, Gaziantep City Hospital, Gaziantep, Turkey.

Department of ICU, Sanliurfa Training and Researh Hospital, Sanliurfa, Turkey.

出版信息

Medicine (Baltimore). 2025 Apr 25;104(17):e42010. doi: 10.1097/MD.0000000000042010.

Abstract

The utility of lung ultrasound (LUS) in evaluation of coronavirus disease (COVID-19) with pneumonia has not yet been elucidated. The main objective of study is to determine whether LUS can effectively predict the prognosis in intensive care unit (ICU), including mortality and disease severity. It's also aimed to determine whether LUS will provide a threshold value to predict mortality in COVID-19 cases. In this prospective observational study, 90 patients admitted to the ICU with COVID-19 pneumonia and respiratory failure were included. A LUS cutoff score of 21 on admission demonstrated sensitivity of 97% and specificity of 68% for predicting mortality. Baseline LUS scores were found to be significantly higher in nonsurvivor group(P < .001) whereas APACHE II, sequential organ failure assessment (SOFA), charlson comorbidity index (CCI), nutrition risk in critically ill (NUTRIC) scores, serum lactate, procalcitonin, ferritin, D-dimer levels and heart rate were also significantly found to be higher in nonsurvivor group(P < .05). Overall mean progression-free-survival (PFS) rate was significantly longer in patients with LUS scores < 21, (mean-survival 23.8 days) compared to those with LUS scores ≥ 21 (mean-survival 12.5 days) (P < .05). Multivariate Cox-regression analysis identified a LUS score ≥ 21 was an independent risk factor for mortality during ICU stay (P = .002). LUS performed at ICU admission can serve as a prognostic indicator for patients with COVID-19 pneumonia. By identifying high-risk groups and monitoring these patients closely using LUS, healthcare providers may enhance resource utilization and potentially improve patient outcomes.

摘要

肺部超声(LUS)在评估冠状病毒病(COVID-19)合并肺炎方面的效用尚未阐明。本研究的主要目的是确定LUS是否能有效预测重症监护病房(ICU)患者的预后,包括死亡率和疾病严重程度。其还旨在确定LUS是否能提供一个预测COVID-19病例死亡率的阈值。在这项前瞻性观察性研究中,纳入了90例因COVID-19肺炎和呼吸衰竭入住ICU的患者。入院时LUS截断分数为21,预测死亡率的敏感性为97%,特异性为68%。发现非存活组的基线LUS分数显著更高(P < 0.001),而非存活组的急性生理与慢性健康状况评分系统II(APACHE II)、序贯器官衰竭评估(SOFA)、查尔森合并症指数(CCI)、危重症营养风险(NUTRIC)评分、血清乳酸、降钙素原、铁蛋白、D-二聚体水平和心率也显著更高(P < 0.05)。与LUS分数≥21的患者(平均生存12.5天)相比,LUS分数<21的患者总体无进展生存期(PFS)率显著更长(平均生存23.8天)(P < 0.05)。多因素Cox回归分析确定,LUS分数≥21是ICU住院期间死亡的独立危险因素(P = 0.002)。在ICU入院时进行的LUS可作为COVID-19肺炎患者的预后指标。通过识别高危人群并使用LUS密切监测这些患者,医疗服务提供者可以提高资源利用效率,并可能改善患者预后。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/3394/12040021/e16fba075e4b/medi-104-e42010-g001.jpg

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