Lung ultrasound score severity cut-off points in COVID-19 pneumonia. A systematic review and validating cohort

Gil-Rodríguez, Jaime; Martos-Ruiz, Michel; Fernández, Alberto Benavente; Aranda-Laserna, Pablo; Alonso, Miguel Ángel Montero; Peregrina-Rivas, José-Antonio; Fernández-Reyes, Daniel; Victoria-Carazo, Javier Martínez de; Guirao-Arrabal, Emilio; Hernández-Quero, José

doi:10.1016/j.medcle.2023.01.023

Cited by 1 publication

(5 citation statements)

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“…Conversely, those with a LUS score ≥17 may benefit from more intensive monitoring or earlier oxygen therapy intervention. These results align with those observed in another hospital center in Spain [ 18 ].…”

Section: Discussionsupporting

confidence: 92%

“…Also, the odds of adverse outcomes (in-hospital death, need for IMV, ICU admission) was almost four times higher in patients with LUS score ≥17 on admission than in those with a lower LUS score. A recent systematic review, including 11 studies, identified two 12-zone LUS score cut-offs, i.e., ≥15 [ 34 ] and ≥19.5 [ 20 ], as predictors of poor outcome (ventilation support, ICU admission, or 28-day mortality) in adults hospitalized with COVID-19 pneumonia [ 18 ]. Our data point in the same direction, towards a consensus for the LUS cut-off for prognosis and thus decision-making in COVID-19 pneumonia.…”

Section: Discussionmentioning

confidence: 99%

“…Similarly, a 12-zone LUS score cut-off ≥17 has been reported to be independently associated with in-hospital mortality among 37 hospitalized COVID-19 patients older than 65 years of age in Italy [ 35 ]. The systematic review previously mentioned [ 18 ] did not identify any LUS score cut-off being predictive of 28-day in-hospital mortality. However, this may be explained by the small sample sizes of the reported studies or absence of adjustment for comorbidities.…”

Section: Discussionmentioning

confidence: 99%

“…The 12-zone protocol had been previously validated in various pathologies [16], appeared feasible for clinicians with limited experience in performing ultrasound [17], and, hence, appeared as a suitable option for COVID-19 patients. Subsequent studies have indicated that the 12-zone protocol strikes a good balance between diagnostic accuracy and acquisition time [16,18]. Some studies have shown that LUS score has a significant correlation with oxygen saturation (SpO 2 ) and the fraction of inspired oxygen (FiO 2 ) ratio, as well as the use of mechanical ventilation in patients with COVID-19 pneumonia [19,20].…”

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Evaluation of a Lung Ultrasound Score in Hospitalized Adult Patients with COVID-19 in Barcelona, Spain

Lightowler,

Sander,

García de Casasola Sánchez

et al. 2024

JCM

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Background/Objectives: During the COVID-19 pandemic and the burden on hospital resources, the rapid categorization of high-risk COVID-19 patients became essential, and lung ultrasound (LUS) emerged as an alternative to chest computed tomography, offering speed, non-ionizing, repeatable, and bedside assessments. Various LUS score systems have been used, yet there is no consensus on an optimal severity cut-off. We assessed the performance of a 12-zone LUS score to identify adult COVID-19 patients with severe lung involvement using oxygen saturation (SpO2)/fractional inspired oxygen (FiO2) ratio as a reference standard to define the best cut-off for predicting adverse outcomes. Methods: We conducted a single-centre prospective study (August 2020–April 2021) at Hospital del Mar, Barcelona, Spain. Upon admission to the general ward or intensive care unit (ICU), clinicians performed LUS in adult patients with confirmed COVID-19 pneumonia. Severe lung involvement was defined as a SpO2/FiO2 ratio <315. The LUS score ranged from 0 to 36 based on the aeration patterns. Results: 248 patients were included. The admission LUS score showed moderate performance in identifying a SpO2/FiO2 ratio <315 (area under the ROC curve: 0.71; 95%CI 0.64–0.77). After adjustment for COVID-19 risk factors, an admission LUS score ≥17 was associated with an increased risk of in-hospital death (OR 5.31; 95%CI: 1.38–20.4), ICU admission (OR 3.50; 95%CI: 1.37–8.94) and need for IMV (OR 3.31; 95%CI: 1.19–9.13). Conclusions: Although the admission LUS score had limited performance in identifying severe lung involvement, a cut-off ≥17 score was associated with an increased risk of adverse outcomes. and could play a role in the rapid categorization of COVID-19 pneumonia patients, anticipating the need for advanced care.

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Section: Discussionsupporting

confidence: 92%