A New Lung Ultrasound Protocol Able to Predict Worsening in Patients Affected by Severe Acute Respiratory Syndrome Coronavirus 2 Pneumonia
A New Lung Ultrasound Protocol Able to Predict Worsening in Patients Affected by Severe Acute Respiratory Syndrome Coronavirus 2 Pneumonia
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DOI：
10.1002/jum.15548
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发表时间：
2020-11-06
影响因子：
2.3
通讯作者：
Di Sabatino, Antonio
中科院分区：
文献类型：
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作者：
Perrone, Tiziano;Soldati, Gino;Di Sabatino, Antonio
目的严重急性呼吸综合征冠状病毒2型（SARS-CoV-2）感染可引起重症肺炎，死亡率高。床旁肺部超声（LUS）检查已被证明在这种情况下具有潜在的作用。本研究的目的是评估一种新的LUS方案的潜在预后价值（14个解剖标志的评价，评分为0 - 3分）的SARS-CoV-2肺炎患者的LUS模式以及LUS模式与临床或实验室结果的相关性。2例在内科病房入院时和出院前接受LUS检查。计算LUS总评分，作为每个探索区域的评分总和。我们调查了LUS评分和临床恶化之间的关系，临床恶化定义为高流量氧气支持、重症监护病房入院或30天死亡率的组合作为主要终点。LUS评分+/-SD的平均值在无恶化和有恶化的患者中分别为20.4 +/-8.5和29.2 +/-7.3（P <0.001）。在多变量分析中，校正合并症（> 2），年龄（> 65岁）、性别（男性）和体重指数（>= 25 kg/m（2）），LUS评分和恶化之间的关联（比值比，1.17; 95%置信区间，1.05至1.29; P = 0.003），具有良好的模型区分度（受试者工作特征曲线下面积，0.82）。LUS评分中位数高于24分与恶化几率增加近6倍相关（比值比，5.67; 95%可信区间，1.29至24.8; P = 0.021）。结论肺部超声可作为监测和分层SARS-CoV-2肺部受累患者预后的有效工具。
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.