A New Lung Ultrasound Protocol Able to Predict Worsening in Patients Affected by Severe Acute Respiratory Syndrome Coronavirus 2 Pneumonia

Tiziano Perrone, Gino Soldati, Lucia Padovini, Anna Fiengo, Gianluca Lettieri, Umberto Sabatini, Giulia Gori, Federica Lepore, Matteo Garolfi, Ilaria Palumbo, Riccardo Inchingolo, Andrea Smargiassi, Libertario Demi, Elisa Eleonora Mossolani, Francesco Tursi, Catherine Klersy, Antonio Di Sabatino

Research output: Contribution to journalArticlepeer-review

Abstract

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/m2), 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.

Original languageEnglish
JournalJournal of Ultrasound in Medicine
DOIs
Publication statusAccepted/In press - 2020

Keywords

  • B-line
  • consolidations
  • lung ultrasound
  • severe acute respiratory syndrome coronavirus 2 pneumonia
  • vertical artifacts

ASJC Scopus subject areas

  • Radiological and Ultrasound Technology
  • Radiology Nuclear Medicine and imaging

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