“…In the vast majority of patients, there was a bilateral involvement, with an evident predominance of interstitial lesions (B lines) and the most affected regions were the posteroinferior ones. In contrast to previous studies, we found a higher incidence of subpleural consolidations [ 23 ]. Pleural effusion was detected only in a minority of patients, thus confirming previous reports [ 16 ].…”
The value of serial lung ultrasound (LUS) in patients with COVID-19 is not well defined. In this multicenter prospective observational study, we aimed to assess the prognostic accuracy of serial LUS in patients admitted to hospital due to COVID-19. The serial LUS protocol included two examinations (0–48 h and 72–96 h after admission) using a 10-zones sequence, and a 0 to 5 severity score. Primary combined endpoint was death or the need for invasive mechanical ventilation. Calibration (Hosmer–Lemeshow test and calibration curves), and discrimination power (area under the ROC curve) of both ultrasound exams (SCORE1 and 2), and their difference (DIFFERENTIAL-SCORE) were performed. A total of 469 patients (54.2% women, median age 60 years) were included. The primary endpoint occurred in 51 patients (10.9%). Probability risk tertiles of SCORE1 and SCORE2 (0–11 points, 12–24 points, and ≥25 points) obtained a high calibration. SCORE-2 showed a higher discrimination power than SCORE-1 (AUC 0.72 (0.58–0.85) vs. 0.61 (0.52–0.7)). The DIFFERENTIAL-SCORE showed a higher discrimination power than SCORE-1 and SCORE-2 (AUC 0.78 (0.66–0.9)). An algorithm for clinical decision-making is proposed. Serial lung ultrasound performing two examinations during the first days of hospitalization is an accurate strategy for predicting clinical deterioration of patients with COVID-19.
“…In the vast majority of patients, there was a bilateral involvement, with an evident predominance of interstitial lesions (B lines) and the most affected regions were the posteroinferior ones. In contrast to previous studies, we found a higher incidence of subpleural consolidations [ 23 ]. Pleural effusion was detected only in a minority of patients, thus confirming previous reports [ 16 ].…”
The value of serial lung ultrasound (LUS) in patients with COVID-19 is not well defined. In this multicenter prospective observational study, we aimed to assess the prognostic accuracy of serial LUS in patients admitted to hospital due to COVID-19. The serial LUS protocol included two examinations (0–48 h and 72–96 h after admission) using a 10-zones sequence, and a 0 to 5 severity score. Primary combined endpoint was death or the need for invasive mechanical ventilation. Calibration (Hosmer–Lemeshow test and calibration curves), and discrimination power (area under the ROC curve) of both ultrasound exams (SCORE1 and 2), and their difference (DIFFERENTIAL-SCORE) were performed. A total of 469 patients (54.2% women, median age 60 years) were included. The primary endpoint occurred in 51 patients (10.9%). Probability risk tertiles of SCORE1 and SCORE2 (0–11 points, 12–24 points, and ≥25 points) obtained a high calibration. SCORE-2 showed a higher discrimination power than SCORE-1 (AUC 0.72 (0.58–0.85) vs. 0.61 (0.52–0.7)). The DIFFERENTIAL-SCORE showed a higher discrimination power than SCORE-1 and SCORE-2 (AUC 0.78 (0.66–0.9)). An algorithm for clinical decision-making is proposed. Serial lung ultrasound performing two examinations during the first days of hospitalization is an accurate strategy for predicting clinical deterioration of patients with COVID-19.
“…When performing ROC analysis, a total LUS score of 9 at admission was a reliable cut-off value to rule out death and ICU transfer (sensitivity 100%; specificity 45%), while at 72 hours a cut-off value of 17 accurately predicted the primary outcome (sensitivity 89%; specificity 85%). These data support a possible role of LUS in the choice of the best intensity care setting for the patient [24] .…”
Section: Utility: Discarding Other Diseases and Complicationssupporting
confidence: 70%
“… LUS score < 10 predicts secondary outcome (discharge from the ED) with OR 20.9 Ji et al [22] 280 Non-ICU wards In-hospital mortality 12/0-36 LUS + age + lymphocyte count + comorbidities better predict primary or secondary (ARDS) outcomes than clinical variables only. LUS score > 12 predicts primary or secondary outcomes with 91.9% sensitivity and 90.5% specificity Rubio-Gracia J et al [23] 130 Non-ICU wards Composite of in-hospital death and ICU admission 12/0-48 LUS score > 22 independently predicts primary outcome Casella et al [24] 190 Non-ICU wards Composite of in-hospital death and ICU admission 11/0-33 LUS score at admission predicts primary outcome in the univariate model but in the multivariate model P/F is the only predictive variable. At 72 hours a LUS score predicts the primary outcome with OR 1.36.…”
Section: Utility: Discarding Other Diseases and Complicationsmentioning
“…The protocol consisted of the evaluation of six regions in each hemithorax (two anterior, two lateral, two posterior); a scoring system (0-3) was used to evaluate and grade the presence of interstitial pattern (score 1 or 2) or consolidation (score 3) in each region. Data regarding the value of LUS in predicting the evolution toward ARDS and/or death have been recently published by our [3] and other groups [4]. The examination was repeated again if clinically indicated, mainly in the presence of worsening respiratory condition.…”
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