Point-of-Care Lung Ultrasound Predicts Severe Disease and Death Due to COVID-19: A Prospective Cohort Study.
Point-of-Care Lung Ultrasound Predicts Severe Disease and Death Due to COVID-19: A Prospective Cohort Study.
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护理肺超声超声预测Covid-19引起的严重疾病和死亡：一项前瞻性队列研究。
DOI：
10.1097/cce.0000000000000732
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发表时间：
2022-08
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床旁肺部超声（LUS）在COVID-19住院患者中的临床效用尚不清楚。前瞻性队列研究。2020年4月至2021年9月间，马里兰州的一家大型三级护理中心。严重急性呼吸综合征冠状病毒2型逆转录-聚合酶链反应结果阳性的住院成人（≥ 18岁）。没有。所有患者均使用标准化方案进行扫描，包括12个肺区，并随访以确定临床结局，直至出院和28天时的生命状态。对肺和胸膜线伪影和异常的超声进行独立审查，并确定肺区的平均LUS评分（mLUSS）（范围为0 - 3）。主要结局是在初次超声检查后28天内达到ICU水平护理的时间，定义为高流量氧气、无创或有创机械通气。针对年龄和性别调整的考克斯比例风险回归模型适用于mLUSS和每个超声协变量。共有264名参与者入组研究;中位年龄为61岁，114名参与者（43.2%）为女性。中位mLUSS为1.0（四分位距，0.5-1.3）。入组后，27名参与者（10.0%）继续需要ICU水平的护理，14名（5.3%）随后在28天内死亡。入组时mLUSS的每次增加均与疾病进展至ICU水平治疗（校正风险比[aHR]，3.61; 95% CI，1.27-10.2）和28天死亡率（aHR，3.10; 95% CI，1.29-7.50）相关。胸膜线异常与疾病进展至死亡独立相关（aHR，20.93; CI，3.33-131.30）。mLUSS大于或等于1或LUS上胸膜线变化的受试者随后需要高流量氧气或更高流量氧气的可能性增加。LUS是一种很有前途的工具，可用于在床边评估COVID-19进展的风险。
The clinical utility of point-of-care lung ultrasound (LUS) among hospitalized patients with COVID-19 is unclear. Prospective cohort study. A large tertiary care center in Maryland, between April 2020 and September 2021. Hospitalized adults (≥ 18 yr old) with positive severe acute respiratory syndrome coronavirus 2 reverse transcriptase-polymerase chain reaction results. None. All patients were scanned using a standardized protocol including 12 lung zones and followed to determine clinical outcomes until hospital discharge and vital status at 28 days. Ultrasounds were independently reviewed for lung and pleural line artifacts and abnormalities, and the mean LUS Score (mLUSS) (ranging from 0 to 3) across lung zones was determined. The primary outcome was time to ICU-level care, defined as high-flow oxygen, noninvasive, or invasive mechanical ventilation, within 28 days of the initial ultrasound. Cox proportional hazards regression models adjusted for age and sex were fit for mLUSS and each ultrasound covariate. A total of 264 participants were enrolled in the study; the median age was 61 years and 114 participants (43.2%) were female. The median mLUSS was 1.0 (interquartile range, 0.5–1.3). Following enrollment, 27 participants (10.0%) went on to require ICU-level care, and 14 (5.3%) subsequently died by 28 days. Each increase in mLUSS at enrollment was associated with disease progression to ICU-level care (adjusted hazard ratio [aHR], 3.61; 95% CI, 1.27–10.2) and 28-day mortality (aHR, 3.10; 95% CI, 1.29–7.50). Pleural line abnormalities were independently associated with disease progression to death (aHR, 20.93; CI, 3.33–131.30). Participants with a mLUSS greater than or equal to 1 or pleural line changes on LUS had an increased likelihood of subsequent requirement of high-flow oxygen or greater. LUS is a promising tool for assessing risk of COVID-19 progression at the bedside.