Relevance of B-Lines on Lung Ultrasound in Volume Overload and Pulmonary Congestion: Clinical Correlations and Outcomes in Patients on Hemodialysis

Abstract

Background: Volume overload in patients on hemodialysis (HD) is an independent risk factor for cardiovascular mortality. B-lines detected on lung ultrasound (BLUS) assess extravascular lung water. This raises interest in its utility for assessing volume status and cardiovascular outcomes. Methods: End-stage renal disease patients on HD at the Island Rehab Center being older than 18 years were screened. Patients achieving their dry weight (DW) had a lung ultrasound in a supine position. Scores were classified as mild (0-14), moderate (15-30), and severe (>30) for pulmonary congestion. Patients with more than 60 were further classified as very severe. Patients were followed for cardiac events and death. Results: 81 patients were recruited. 58 were males, with a mean age of 59.7 years. 44 had New York Heart Association (NYHA) class 1, 24 had class 2, and 13 had class 3. In univariate analysis, NYHA class was associated with B-line classes (<0.001) and diastolic dysfunction (0.002). In multivariate analysis, NYHA grade strongly correlated with B-line classification (0.01) but not with heart function (0.95). 71 subjects were followed for a mean duration of 1.19 years. 9 patients died and 20 had an incident cardiac event. A Kaplan-Meier survival analysis demonstrated an interval decrease in survival times in all-cause mortality and cardiac events with increased BLUS scores (p = 0.0049). Multivariate Cox regression analysis showed the independent predictive value of BLUS class for mortality and cardiac events with a heart rate of 2.98 and 7.98 in severe and very severe classes, respectively, compared to patients in the mild class (p = 0.025 and 0.013). Conclusion: At DW, BLUS is an independent risk factor for death and cardiovascular events in patients on HD.

Interobserver Agreement of Lung Ultrasound Findings of COVID-19

“…18 Furthermore, an abnormal LUS scan (outside of COVID-19) has prognostic implications across multiple diseases. [19][20][21] Future studies are needed to determine if LUS can reliably predict clinical outcomes with COVID-19.…”

Associations between pulmonary congestion on chest ultrasound and survival in hemodialysis patients

“…Pulmonary congestion, which can remain after hemodialysis therapy, may also be correlated with a poor outcome. In a recent American study, a multivariate Cox regression analysis showed that the number of Blines at the end of hemodialysis therapy was an independent predictor of mortality [11]. Thorough removal of the water and the prevention of lung congestion at the end of hemodialysis seem to be important for a Fig.…”

“…The relationship between pre-hemodialysis number of B-lines and mortality was already reported [6]. Another investigator reported that the number of B-lines at the end of hemodialysis therapy was related to mortality [11]. There was no report which investigates the relationship between the number of B-lines at the middle of hemodialysis therapy and mortality.…”

Lung Ultrasonography and Cardiac Surgery: A Narrative Review

“…The number of B-lines is directly proportional to the degree of extravascular water accumulation. 38,39 This typically is evaluated using an 8-zone method (4 zones on each side), although a 28-zone method recently has become widespread. [40][41][42] The severity of pulmonary edema can be semiquantified by summing the amount of B-lines in the zones or by determining the number of affected zones.…”