Prognostic value of bedside lung ultrasound score in patients with COVID-19
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RESEARCH
Prognostic value of bedside lung ultrasound score in patients with COVID‑19 Li Ji1,2†, Chunyan Cao1,2†, Ying Gao1,2†, Wen Zhang1,2†, Yuji Xie1,2, Yilian Duan1,2, Shuangshuang Kong1,2, Manjie You1,2, Rong Ma1,2, Lili Jiang1,2, Jie Liu1,2, Zhenxing Sun1,2, Ziming Zhang1,2, Jing Wang1,2, Yali Yang1,2, Qing Lv1,2, Li Zhang1,2, Yuman Li1,2*, Jinxiang Zhang3* and Mingxing Xie1,2*
Abstract Background: Bedside lung ultrasound (LUS) has emerged as a useful and non-invasive tool to detect lung involvement and monitor changes in patients with coronavirus disease 2019 (COVID-19). However, the clinical significance of the LUS score in patients with COVID-19 remains unknown. We aimed to investigate the prognostic value of the LUS score in patients with COVID-19. Method: The LUS protocol consisted of 12 scanning zones and was performed in 280 consecutive patients with COVID-19. The LUS score based on B-lines, lung consolidation and pleural line abnormalities was evaluated. Results: The median time from admission to LUS examinations was 7 days (interquartile range [IQR] 3–10). Patients in the highest LUS score group were more likely to have a lower lymphocyte percentage (LYM%); higher levels of D-dimer, C-reactive protein, hypersensitive troponin I and creatine kinase muscle-brain; more invasive mechanical ventilation therapy; higher incidence of ARDS; and higher mortality than patients in the lowest LUS score group. After a median follow-up of 14 days [IQR, 10–20 days], 37 patients developed ARDS, and 13 died. Patients with adverse outcomes presented a higher rate of bilateral involvement; more involved zones and B-lines, pleural line abnormalities and consolidation; and a higher LUS score than event-free survivors. The Cox models adding the LUS score as a continuous variable (hazard ratio [HR]: 1.05, 95% confidence intervals [CI] 1.02 ~ 1.08; P 12 predicted adverse outcomes with a specificity and sensitivity of 90.5% and 91.9%, respectively. Conclusions: The LUS score devised by our group performs well at predicting adverse outcomes in patients with COVID-19 and is important for risk stratification in COVID-19 patients. Keywords: COVID-19, Lung ultrasound, LUS score, Acute respiratory distress syndrome (ARDS), Prognosis
*Correspondence: [email protected]; [email protected]; [email protected] † Li Ji, Chunyan Cao, Ying Gao, Wen Zhang contributed equally to this work 1 Department of Ultrasound, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, 1277# Jiefang Ave, Wuhan 430022, China 3 Department of Emergency Surgery, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, 1277# Jiefang Ave, Wuhan 430022, China Full list of author information is available at the end of the article
Background Coronavirus disease 2019 (COVID-19) caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) has become a global threat, resulting in severe illnesses such as acute respiratory distress syndrome (ARDS), multi-organ dysfunction
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