Integrated lung ultrasound score for early clinical decision-making in patients with COVID-19: results and implications

Abstract

Background and objectives Lung Ultrasound Score (LUS) identifies and monitors pneumonia by assigning increasing scores. However, it does not include parameters, such as inferior vena cava (IVC) diameter and index of collapse, diaphragmatic excursions and search for pleural and pericardial effusions. Therefore, we propose a new improved scoring system, termed “integrated” lung ultrasound score (i-LUS) which incorporates previously mentioned parameters that can help in prediction of disease severity and survival, choice of oxygenation mode/ventilation and assignment to subsequent areas of care in patients with COVID-19 pneumonia. Methods Upon admission at the sub-intensive section of the emergency medical department (SEMD), 143 consecutively examined COVID-19 patients underwent i-LUS together with all other routine analysis. A database for anamnestic information, laboratory data, gas analysis and i-LUS parameters was created and analyzed. Results Of 143 enrolled patients, 59.4% were male (mean age 71 years) and 40.6% female. (mean age 79 years: p = 0.005). Patients that survived at 1 month had i-LUS score of 16, which was lower than that of non-survivors (median 20; p = 0.005). Survivors had a higher PaO2/FiO2 (median 321.5) compared to non-survivors (median 229, p < 0.001). There was a correlation between i-LUS and PaO2/FiO2 ratio (rho:-0.4452; p < 0.001), PaO2/FiO2 and survival status (rho:-0.3452; p < 0.001), as well as i-LUS score and disease outcome (rho:0.24; p = 0.005). In non-survivors, the serum values of different significant COVID indicators were severely expressed. The i-LUS score was higher (median 20) in patients who required non-invasive ventilation (NIV) than in those treated only by oxygen therapy (median 15.42; p = 0.003). The odds ratio for death outcome was 1.08 (confidence interval 1.02–1.15) for each point increased. At 1-month follow-up, 65 patients (45.5%) died and 78 (54.5%) survived. Patients admitted to the high critical ward had higher i-LUS score than those admitted to the low critical one (p < 0.003). Conclusions i-LUS could be used as a helpful clinical tool for early decision-making in patients with COVID-19 pneumonia.

Lung Ultrasound in Adults and Children with COVID-19: From First Discoveries to Recent Advances

“…Recently, Dell’Acquila et al questioned the fact that the LUS score does not include parameters such as inferior vena cava (IVC) diameter, the index of collapsibility or distensibility, diaphragmatic excursions and the evaluation of pleural and pericardial effusions [ 25 ]. They proposed a new scoring system, termed “integrated00” lung ultrasound score (i-LUS), which incorporates the inferior vena cava (IVC), diaphragmatic excursions and pleural and pericardial effusions.…”

“…They proposed a new scoring system, termed “integrated00” lung ultrasound score (i-LUS), which incorporates the inferior vena cava (IVC), diaphragmatic excursions and pleural and pericardial effusions. They found that i-LUS could be a helpful clinical tool for early decision making in patients with COVID-19 pneumonia [ 25 ].…”

SARS-CoV-2 and Endothelial Cells: Vascular Changes, Intussusceptive Microvascular Growth and Novel Therapeutic Windows

“…Looking at the ACE2 receptor in the olfactory bulb, the investigators found the highest receptor concentration in both vascular endothelial cells and pericytes [ 14 ]. Collectively, the evidence points towards vascular endothelialitis, affecting the lung, the cardiovascular system, the brain, and the olfactory organ [ 15 , 16 , 17 ]. Vascular events such as microthrombi and intussusceptive microvascular growth can develop from a systemic activation of inflammatory cascades mediated by massive cytokines release [ 18 ].…”

Letter to the Editor: “Lung ultrasound to predict gas-exchange response to prone positioning in COVID-19 patients: A prospective study in pilot and confirmation cohorts”

“…The latter takes into consideration important parameters for clinical decision-making such as inferior vena cava (IVC) diameter and index of collapse, diaphragmatic excursions and search for pleural and pericardial effusions. A 2022 study that assessed the value and implications of i-LUS for COVID-19 patients found it be clinically potentially superior to LUS [ 3 ]. Moreover, we wonder why authors exclusively reported sequential organ failure assessment (SOFA) scores, instead of the more recently-developed COVID-SOFA scores, which have been found to be a better criterion for mortality prediction in COVID-19 patients [ 4 ].…”