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A New Lung Ultrasound Protocol Able to Predict Worsening in Patients Affected by Severe Acute Respiratory Syndrome Coronavirus 2 Pneumonia
Author(s) -
Perrone Tiziano,
Soldati Gino,
Padovini Lucia,
Fiengo Anna,
Lettieri Gianluca,
Sabatini Umberto,
Gori Giulia,
Lepore Federica,
Garolfi Matteo,
Palumbo Ilaria,
Inchingolo Riccardo,
Smargiassi Andrea,
Demi Libertario,
Mossolani Elisa Eleonora,
Tursi Francesco,
Klersy Catherine,
Di Sabatino Antonio
Publication year - 2021
Publication title -
journal of ultrasound in medicine
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.574
H-Index - 91
eISSN - 1550-9613
pISSN - 0278-4297
DOI - 10.1002/jum.15548
Subject(s) - medicine , pneumonia , confidence interval , odds ratio , intensive care unit , receiver operating characteristic , area under the curve , lung ultrasound , cohort , lung
Objectives Severe acute respiratory syndrome coronavirus 2 (SARS‐CoV‐2) infection can generate severe pneumonia associated with high mortality. A bedside lung ultrasound (LUS) examination has been shown to have a potential role in this setting. The purpose of this study was to evaluate the potential prognostic value of a new LUS protocol (evaluation of 14 anatomic landmarks, with graded scores of 0–3) in patients with SARS‐CoV‐2 pneumonia and the association of LUS patterns with clinical or laboratory findings. Methods A cohort of 52 consecutive patients with laboratory‐confirmed SARS‐CoV‐2 underwent LUS examinations on admission in an internal medicine ward and before their discharge. A total LUS score as the sum of the scores at each explored area was computed. We investigated the association between the LUS score and clinical worsening, defined as a combination of high‐flow oxygen support, intensive care unit admission, or 30‐day mortality as the primary end point. Results Twenty (39%) patients showed a worse outcome during the observation period; the mean LUS scores ± SDs were 20.4 ± 8.5 and 29.2 ± 7.3 in patients without and with worsening, respectively ( P < .001). In a multivariable analysis, adjusted for comorbidities (>2), age (>65 years), sex (male), and body mass index (≥25 kg/m 2 ), the association between the LUS score and worsening (odds ratio, 1.17; 95% confidence interval, 1.05 to 1.29; P = .003) was confirmed, with good discrimination of the model (area under the receiver operating characteristic curve, 0.82). A median LUS score higher than 24 was associated with an almost 6‐fold increase in the odds of worsening (odds ratio, 5.67; 95% confidence interval, 1.29 to 24.8; P = .021). Conclusions Lung ultrasound can represent an effective tool for monitoring and stratifying the prognosis of patients with SARS‐CoV‐2 pulmonary involvement.