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

Saad, Marc; Kamal, Jeanne; Moussaly, Elias; Karam, Boutros; Mansour, Wissam; Gobran, Emad; Abbasi, Saqib Hussen; Mahgoub, Ahmed; Singh, Pushpendra; Hardy, Ross; Das, Devjani; Brown, Cara; Kapoor, Monica; Demissie, Seleshi; Kleiner, Morton; Charabaty, Elie El; Sayegh, Suzanne El

doi:10.1159/000476000

Cited by 32 publications

(30 citation statements)

References 25 publications

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“…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.…”

Section: Discussionmentioning

confidence: 99%

Interobserver Agreement of Lung Ultrasound Findings of COVID-19

Kumar

Weng

Graglia

et al. 2020

Preprint

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Background: Lung ultrasound (LUS) may be used in the diagnostic evaluation of patients with COVID-19. An abnormal LUS is associated with increased risk for ICU admission in COVID-19. Previously described LUS manifestations for COVID-19 include B-lines, consolidations, and pleural thickening. The interrater reliability (IRR) of these findings for COVID-19 is unknown. Research Question: What is the interrater reliability of lung ultrasound findings in patients with RT-PCR confirmed COVID-19? Study Design and Methods: This study was conducted at conducted at two academic medical centers between 03/2020-06/2020. Nine physicians (hospitalists: n=4; emergency medicine: n=5) independently evaluated n=20 LUS scans (n=180 independent observations) collected from RT-PCR confirmed COVID-19 patients. These studies were randomly selected from an image database consisting of COVID-19 patients evaluated in the emergency department with portable ultrasound devices. Physicians were blinded to any patient information or previous LUS interpretation. Kappa values were used to calculate IRR. Results: There was substantial IRR on the following items: normal LUS scan (K=0.79 [95% CI: 0.72-0.87]), presence of B-lines (K=0.79 [95% CI: 0.72-0.87]), >=3 B-lines observed (K=0.72 [95% CI: 0.64-0.79]). Moderate IRR was observed for the presence of any consolidation (K=0.57 [95% CI: 0.50-0.64]), subpleural consolidation (K=0.49 [95% CI: 0.42-0.56]), and presence of effusion (K=0.49 [95% CI: 0.41-0.56]). Fair IRR was observed for pleural thickening (K=0.23 [95% CI: 0.15-0.30]). Interpretation: Many LUS manifestations for COVID-19 appear to have moderate to substantial IRR across providers from multiple specialties utilizing differing portable devices. The most reliable LUS findings with COVID-19 may include the presence/count of B-lines or determining if a scan is normal. Clinical protocols for LUS with COVID-19 may require additional observers for the confirmation of less reliable findings such as consolidations.

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Section: Discussionmentioning

confidence: 99%

Interobserver Agreement of Lung Ultrasound Findings of COVID-19

Kumar

Weng

Graglia

et al. 2020

Preprint

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“…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.…”

Section: Discussionmentioning

confidence: 97%

“…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.…”

Section: Introductionmentioning

confidence: 99%

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

et al. 2019

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Background: Volume overload in hemodialysis patients is an independent risk factor for cardiovascular eventrelated mortality. The number of B-lines observed using lung ultrasound is correlated with the severity of pulmonary congestion. The aim of this study was to evaluate the association between the number of B-lines and mortality among hemodialysis patients. Methods: A total of 61 patients receiving maintenance hemodialysis were enrolled in this study. Clinical data including age, sex, duration of hemodialysis therapy, presence of diabetes mellitus and/or hypertension and/or dyslipidemia complications, the results of biological examinations, and outcome were collected from the patients' clinical records. We performed echographic examinations at three time points (just after the start, during the middle, and just before the end of hemodialysis therapy). A univariate Cox proportional hazard model was used to identify predictors of the overall outcomes. Furthermore, we divided patients into two groups according to the median number of the B-lines at the end of dialysis and compared the mortality between the two groups. Results: The mean follow-up period was 507 ± 385 days. During the follow-up period, 24 deaths were recorded. Predictive variables for mortality included age; serum level of albumin, creatinine, and N-terminal pro-brain natriuretic peptide; and body weight (P < 0.001, P < 0.0001, P < 0.001, P = 0.014, and P = 0.019, respectively). The number of B-lines at the start, middle, and end of dialysis therapy was correlated with mortality (hazard ratio (95% confidence interval) 1.20 (1.09-1.32), P = 0.0002; 1.17 (1.07-1.28), P = 0.0008; and 1.23 (1.12-1.37), P = 0.0001; respectively). The mortality was statistically higher in the group with 5 or more B-lines than in the group with less than 5 B-lines (P = 0.013). Conclusions: The number of B-lines at the start, middle, and end of hemodialysis therapy may be correlated with mortality among hemodialysis patients.

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“…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.…”

Section: Diaphragm Dysfunctionmentioning

confidence: 99%