BackgroundLung ultrasound (LUS) is feasible for assessing lung injury caused by COVID-19. However, the prognostic meaning and time-line changes of lung injury assessed by LUS in COVID-19 hospitalised patients, is unknown.MethodsProspective cohort study designed to analyse prognostic value of LUS in COVID-19 patients by using a quantitative scale (LUZ-score) during the first 72 h after admission. Primary endpoint was in-hospital death and/or admission to the intensive care unit. Total length of hospital stay, increase of oxygen flow or escalate medical treatment during the first 72 h, were secondary endpoints.Results130 patients were included in the final analysis; mean age was 56.7±13.5 years. Time since the beginning of symptoms until admission was 6 days (4–9). Lung injury assessed by LUZ-score did not differ during the first 72 h (21 points [16–26] at admission versus 20 points [16–27] at 72 h; p=0.183). In univariable logistic regression analysis estimated PaO2/FiO2 (HR 0.99 [0.98–0.99]; p=0.027) and LUZ-score>22 points (5.45 (1.42–20.90); p=0.013) were predictors for the primary endpoint.ConclusionsLUZ-score is an easy, simple and fast point of care ultrasound tool to identify patients with severe lung injury due to COVID-19, upon admission. Baseline score is predictive of severity along the whole period of hospitalisation. The score facilitates early implementation or intensification of treatment for COVID-19 infection. LUZ-score may be combined with clinical variables (as estimated PAFI) to further refine risk stratification.

Although several biomarkers have shown correlation to prognosis in COVID-19 patients, their clinical value is limited because of lack of specificity, suboptimal sensibility or poor dynamic behavior. We hypothesized that circulating soluble ST2 (sST2) could be associated to a worse outcome in COVID-19. In total, 152 patients admitted for confirmed COVID-19 were included in a prospective non-interventional, observational study. Blood samples were drawn at admission, 48–72 h later and at discharge. sST2 concentrations and routine blood laboratory were analyzed. Primary endpoints were admission at intensive care unit (ICU) and mortality. Median age was 57.5 years [Standard Deviation (SD: 12.8)], 60.4% males. 10% of patients (n = 15) were derived to ICU and/or died during admission. Median (IQR) sST2 serum concentration (ng/mL) rose to 53.1 (30.9) at admission, peaked at 48–72 h (79.5(64)) and returned to admission levels at discharge (44.9[36.7]). A concentration of sST2 above 58.9 ng/mL was identified patients progressing to ICU admission or death. Results remained significant after multivariable analysis. The area under the receiver operating characteristics curve (AUC) of sST2 for endpoints was 0.776 (p = 0.001). In patients admitted for COVID-19 infection, early measurement of sST2 was able to identify patients at risk of severe complications or death.

ImportanceAlthough several biomarkers have shown correlation to prognosis in COVID-19 patients, their clinical value is limited because of lack of specificity, suboptimal sensibility, or poor dynamic behavior.ObjectiveIn search of better prognostic markers in COVID-19, we hypothesized that circulating soluble ST2 (sST2) could be associated to a worse outcome, prompted by our previous knowledge of sST2 involvement in heart failure-associated lung deterioration, and by mounting evidence favoring a role of IL-33/ST2 axis in the disease.Design, Setting and participantsOne hundred and fifty-two patients admitted for confirmed COVID-19 infection were included in a prospective non-interventional, observational study carried out in a tertiary teaching center. Blood samples were drawn at admission, 48-72 hours later and at discharge. sST2 concentrations, and routine blood laboratory were analyzed.Main outcomesPrimary end-points were admission at intensive care unit (ICU) and, mortality. Other outcomes were a need for high oxygen flow therapy (HOF) or increasing treatment at 48/72 hours.ResultsMedian age was 57.5 years (SD: 12.8), 60.4% males. Ten per cent of patients (n=15) were derived to ICU and/or died during admission. The rest stayed hospitalized 8(IQR:6) days on average. About 34% (n=47), 38% (n=53) and 48.5% (n=66) needed HOF, up-titrate therapy or both, respectively.Median (IQR) sST2 serum concentration (ng/mL) rose to 53.1(30.9) at admission, peaked at 48-72h (79.5[64]) and returned to admission levels at discharge (44.9[36.7]), remaining significantly elevated above healthy donor values (18.6[15.1]).A concentration of sST2 above 58.9 ng/mL identified patients progressing to ICU admission or death. These results remained significant after multivariable analysis. The area under the receiver operating characteristics curve (AUC) of sST2 for the occurrence of end-points was 0.776 (p=0.001). Admission sST2 was higher in patients who needed up-tritate therapy.Conclusions and relevanceIn patients admitted for COVID-19 infection, measurement of sST2 measurement early within 24h after at admission was able to identify patients at risk of severe complications or death.

Aims Increased intra-abdominal pressure (IAP) is now considered a potential contributor to organ damage and disease progression in acute heart failure (AHF). In this work, we aimed to determine if antigen carbohydrate 125 (CA125) is associated with IAP and to identify a cutpoint of CA125 useful for ruling out intra-abdominal hypertension (defined as IAP ≥ 12 mmHg). Methods and results We prospectively evaluated a cohort of 53 patients admitted with AHF in which IAP was measured within the first 24-h of admission. The mean age was 80 ± 8 years, 31 (58.5%) were female, and 31 (58.5%) had left ventricular ejection fraction ≥50%. The median plasma levels of NT-proBNP and CA125 were 3830 pg/mL (2417–8929) and 45.8 U/mL (29.8–114.0), respectively. The median of IAP was 15 mmHg (11–17), and 39 (73%) patients had an IAP ≥ 12 mmHg. The diagnostic performance of CA125 for identifying an IAP ≥ 12 mmHg was tested using the receiving operating characteristic (ROC) curve. The cut-off for CA125 of 17.1 U/mL showed a sensitivity of 92%, a specificity of 50%, and an area under the ROC curve of 0.71. After multivariate adjustment, CA125 remained non-linearly and positively associated with higher IAP (P-value = 0.003), explaining almost 28% of the model’s variability (R2: 27.6%). Conclusions Patients with AHF and intra-abdominal hypertension had higher CA125 plasma levels. A baseline concentration of CA125 below 17.1 U/mL will increase the odds of identifying a subset of patients with normal IAP.