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Prognostic value of bedside lung ultrasound score in patients with COVID-19
Li Ji1,2, Chunyan Cao1,2, Ying Gao1,2
1Department of Ultrasound, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, 1277# Jiefang Ave, Wuhan, 430022, China.
Insights
The lung ultrasound score (LUS) effectively predicts adverse outcomes in COVID-19 patients, aiding in risk stratification. A score over 12 indicates a higher likelihood of poor prognosis.
Area of Science:
- Medical Imaging
- Pulmonology
- Infectious Diseases
Background:
- Bedside lung ultrasound (LUS) is a non-invasive tool for detecting lung involvement in COVID-19.
- The prognostic significance of the LUS score in COVID-19 patients was previously unknown.
Purpose of the Study:
- To investigate the prognostic value of the LUS score in patients diagnosed with COVID-19.
- To determine if LUS score can predict adverse outcomes and mortality in COVID-19.
Main Methods:
- A 12-zone LUS protocol was applied to 280 COVID-19 patients.
- The LUS score was calculated based on B-lines, lung consolidation, and pleural line abnormalities.
- Cox models were used to assess the predictive accuracy of the LUS score for adverse outcomes.
Main Results:
- Higher LUS scores correlated with lower lymphocyte counts, elevated inflammatory markers (D-dimer, CRP), increased need for mechanical ventilation, higher ARDS incidence, and greater mortality.
- An LUS score > 12 demonstrated high sensitivity (91.9%) and specificity (90.5%) in predicting adverse outcomes.
- The LUS score significantly improved the accuracy of predicting poor outcomes compared to a basic model (C-index 0.903 vs. 0.866).
Conclusions:
- The developed LUS score is a valuable tool for predicting adverse outcomes in COVID-19 patients.
- LUS scoring is crucial for effective risk stratification and management of COVID-19 patients.
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 < 0.001; Akaike information criterion [AIC] = 272; C-index = 0.903) or as a categorical variable (HR 10.76, 95% CI 2.75 ~ 42.05; P = 0.001; AIC = 272; C-index = 0.902) were found to predict poor outcomes more accurately than the basic model (AIC = 286; C-index = 0.866). An LUS score cut-off > 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.
