Risk Stratification in COVID-19 Pneumonia – Determining the Role of Lung Ultrasound

Abstract

LUS patterns of COVID-19 pneumonia have been described and shown to be characteristic. The aim of the study was to predict the prognosis of patients with COVID-19 pneumonia, using a score based on LUS findings. Materials and Methods An observational, retrospective study was conducted on patients admitted to Niguarda hospital with a diagnosis of COVID-19 pneumonia during the period of a month, from March 2nd to April 3rd 2020. Demographics, clinical, laboratory, and radiological findings were collected. LUS was performed in all patients. The chest was divided into 12 areas. The LUS report was drafted using a score from 0 to 3 with 0 corresponding to A pattern, 1 corresponding to well separated vertical artifacts (B lines), 2 corresponding to white lung and small consolidations, 3 corresponding to wide consolidations. The total score results from the sum of the scores for each area. The primary outcome was endotracheal intubation, no active further management, or death. The secondary outcome was discharge from the emergency room (ER). Results 255 patients were enrolled. 93.7 % had a positive LUS. ETI was performed in 43 patients, and 24 received a DNI order. The general mortality rate was 15.7 %. Male sex (OR 3.04, p = 0.014), cardiovascular disease and hypertension (OR 2.75, p = 0.006), P/F (OR 0.99, p < 0.001) and an LUS score > 20 (OR 2.52, p = 0.046) were independent risk factors associated with the primary outcome. Receiver operating characteristic (ROC) curve analysis for an LUS score > 20 was performed with an AUC of 0.837. Independent risk factors associated with the secondary outcome were age (OR 0.96, p = 0.073), BMI (OR 0.87, p = 0,13), P/F (OR 1.03, p < 0.001), and LUS score < 10 (OR 20.9, p = 0.006). ROC curve analysis was performed using an LUS score < 10 with an AUC 0.967. Conclusion The extent of lung abnormalities evaluated by LUS score is a predictor of a worse outcome, ETI, or death. Moreover, the LUS score could be an additional tool for the safe discharge of patient from the ER.

Prognostic Significance of Chest Imaging by LUS and CT in COVID-19 Inpatients: The ECOVID Multicenter Study

“…In this study, we found that LUS score is a valuable tool not only to reveal the presence of and quantify the parenchymal damage from the SARS-CoV-2 infection but also for predicting clinical deterioration and mortality in COVID-19 in patients. COVID-19 pneumonia can show a plethora of ultrasound abnormalities, such as B-lines, pleural line abnormalities, significant consolidations and bilateral involvement, expression of deep parenchymal damage, and impairment [ 11 , 12 ]. Beyond the LUS usefulness in terms of diagnostic yield, LUS seems to be effective also to predict the patient's outcome.…”

Role of Lung Ultrasound in the Management of Patients with Suspected SARS-Cov-2 Infection in the Emergency Department

“…Several studies reported different LUS score values as predictors of mortality and hospitalization in intensive care [20][21][22][23][24][25]; those differences are probably due to the different care settings of the various hospitals; in our case, many of the patients examined went to the emergency room few days after the onset of symptoms (mean of 5 days). This made it possible to immediately evaluate patients, often during a non-critical phase of the disease, allowing the best therapy to be set immediately and establishing the best care setting.…”

“…Another work by Tombini et al showed that LUS score > 20 was presented the best diagnostic accuracy for the primary outcome (endotracheal intubation, no active further management or death); in the same work, a LUS score < 10 presented the best diagnostic accuracy for the secondary outcome (discharge from the emergency room) [23].…”

Lung ultrasound in COVID-19: Insights from the frontline and research experiences

“…The categorized value of LUS score (LUS score >20) was independently associated with the composite outcome of death, need for mechanical ventilation and dispatch for no active further management, together with age, body mass index, P/F and cardiovascular morbidity/hypertension. On the other hand, a LUS score <10 was an independent predictor for a safe discharge from the ED [21] .…”

“…Discharged patients had LUS score < 7, no readmission. (P/F mean 306 (37-704)) Tombini et al [21] 255 ED Composite of endotracheal intubation, no active further management, or death 12/0-36 LUS score > 20 predicts primary outcome with OR 2.52. 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.…”