Lung Ultrasound, Clinical and Analytic Scoring Systems as Prognostic Tools in SARS-CoV-2 Pneumonia: A Validating Cohort

Abstract

At the moment, several COVID-19 scoring systems have been developed. It is necessary to determine which one better predicts a poor outcome of the disease. We conducted a single-center prospective cohort study to validate four COVID-19 prognosis scores in adult patients with confirmed infection at ward. These are National Early Warning Score (NEWS) 2, Lung Ultrasound Score (LUS), COVID-19 Worsening Score (COWS), and Spanish Society of Infectious Diseases and Clinical Microbiology score (SEIMC Score). Our outcomes were the combined variable “poor outcome” (non-invasive mechanical ventilation, intubation, intensive care unit admission, and death at 28 days) and death at 28 days. Scores were analysed using univariate logistic regression models, receiver operating characteristic curves, and areas under the curve. Eighty-one patients were included, from which 21 had a poor outcome, and 9 died. We found a statistically significant correlation between poor outcome and NEWS2, LUS > 15, and COWS. Death at 28 days was statistically correlated with NEWS2 and SEIMC Score although COWS also performs well. NEWS2, LUS, and COWS accurately predict poor outcome; and NEWS2, SEIMC Score, and COWS are useful for anticipating death at 28 days. Lung ultrasound is a diagnostic tool that should be included in COVID-19 patients evaluation.

Lung ultrasound scan score can identify pulmonary embolism high risk in patients with COVID-19: a retrospective analysis from a single center

“…The role of LUS in general wards or in sub-intensive areas for treatment of acute respiratory failure of any type, in fact, has been already underlined. [33][34][35] Yet, studies that evaluated the combined prognostic role of pro-BNP and LUS score toward morbidity and mortality for PE or acute respiratory distress syndrome in inpatients with COVID-19 are lacking and with non-univocal results, in particular, because COVID-19 has been associated with an excess of PE per se since first wave. [36][37][38][39][40] Probably, because of the high impact of the pandemic also the role of traditional biomarkers (i.e., troponin and D-dimer) in this clinical setting has been doubtful and for this reason, epidemiological studies looking for other prognostic biomarkers are still active.…”

Thoracic Ultrasound in Lung Transplantation—Insights in the Field

“…Thoracic ultrasound (TUS) has gradually been accepted as a chest imaging modality with high diagnostic and monitoring accuracy for a variety of respiratory diseases and conditions and thus is being increasingly used by a broad range of clinical specialties within respiratory medicine, intensive care, and emergency medicine [ 1 ]. Not least, TUS has gained further popularity, secondary to its growing use during the COVID-19 pandemic as part of the risk stratification to predict respiratory failure and admission to intensive care units, including prognostication in those patients suffering from acute respiratory distress syndrome [ 2 , 3 ].…”