The lung ultrasound “Rule of 7” in the prognosis of COVID-19 patients: Results from a prospective multicentric study

Abstract

Objetivo: Existe una evidencia creciente con respecto a los hallazgos de imagen de la enfermedad por coronavirus 2019 (COVID-19) en la ecografía pulmonar (LUS), sin embargo, aún no se ha explorado el uso de una herramienta combinada de pronóstico y triaje. El objetivo principal de este estudio fue determinar el impacto de la LUS en la predicción de la mortalidad de los pacientes con sospecha de afectación pulmonar por COVID-19. El objetivo secundario fue calcular una puntuación con los hallazgos del LUS con otras variables para predecir el ingreso hospitalario y el alta del servicio de urgencias (SU). Material y métodos: Estudio prospectivo realizado en urgencias de tres hospitales académicos, en pacientes con sospecha de COVID-19 o confirmación de esta, a los que se sometió a un examen de LUS y pruebas de laboratorio. Resultados: Se inscribieron un total de 228 pacientes entre marzo y septiembre de 2020. La edad media fue de 61,9 años (Desviación estándar - DE 21,1). El hallazgo más común en la LUS fue la irregularidad pleural posteroinferior derecha (53,9%, 123 pacientes). Se calculó un modelo de regresión logística, que incluyó la edad mayor de 70 años, proteína C reactiva (PCR) mayor de 70 g / L y puntuación de afectación pulmonar mediante LUS score superior a 7 para predecir la mortalidad, el ingreso hospitalario y el alta del SU. Se obtuvo una sensibilidad del 56,8% y una especificidad del 87,6%, con un AUC de 0,813 [p <0,001] para dicho modelo predictivo, en materia de mortalidad. Conclusiones: La combinación de LUS, hallazgos clínicos y de laboratorio en esta “regla de 7” de fácil aplicación se mostró de utilidad para predecir el ingreso hospitalario y la mortalidad.

Comparison of lung ultrasound scoring systems for the prognosis of COVID‐19 in the emergency department: An international prospective cohort study

“…The multicentre, prospective cohort study by Sun et al 27 in February to March 2020 recruited 402 patients in Wuhan, China, who presented to ED with COVID-19, had the LUS scores > 15/36 (12-region protocol) that predicted mortality, but may have been biased by including patients who were discharged. Conversely, two studies were similar to our eligibility criteria, the single-centre, prospective cohort study by de Alencar et al 9 from March to May 2020 demonstrated that 180 patients in Brazil, with the LUS scores > 18/36 (12-region protocol), and the multicentre, prospective cohort study by Tung-Chen et al 7 from March to September 2020 in Spain, with the LUS scores > 10, in combination with other markers, were both predictive of mortality.…”

Prognostic and discriminatory abilities of imaging scoring systems in predicting COVID‐19 adverse outcomes

“…In COVID‐19 diagnosis, a meta‐analysis pointed out that CT is sensitive and moderately specific while chest X‐ray is moderately sensitive and specific, and Ultrasound is sensitive but not specific, thus chest CT and ultrasound are more useful for ruling out COVID‐19 infection [3]. Several studies have discussed the use of one of the imaging scoring systems in prediction of COVID‐19's outcomes but no meta‐analysis had compared between them in predicting COVID's outcomes.…”

“…Several studies and meta‐analyses have been done on the role of different imaging modalities such as X‐ray, computed tomography (CT), and ultrasound in COVID‐19 diagnosis. COVID 19 imaging findings have been reported in lots of studies; however, the use of a combined prognostic and triage tool has not been explored yet [3]. The prognostic importance of imaging modalities and their role in the risk stratification of patients already diagnosed with COVID‐19 have not yet been established.…”

Simplified Lung Ultrasound Examination and Telehealth Feasibility in Early SARS-CoV-2 Infection

“…Ultrasound ring-down artifacts called B-lines, or the ULC as defined in this study, have been described in COVID-19 and relate to prognosis. [3][4][5][6][7][8][9][10][11][12][13][14]19 ULC is highly sensitive for an abnormal interstitium 3,7 and can be present when radiographic findings are normal. 26,27 When found in the easily accessed lung anteroapical location, B-lines are unlikely to be due to gravity-dependent edema or aspiration and may be more specific for direct infection and the immune response, as the apices may be particularly prone to inhaled pathogens, formation of oxygen-free radicals, and poor lymphatic drainage.…”

“…1 Involvement of the lung has been the driving force for COVID-19 hospitalization and mortality 2 and can be easily detected by ultrasound. [3][4][5] Prior hospital-based point-of-care ultrasound studies of the lung have shown prevalence and prognostic value to the finding of B-lines, [6][7][8][9][10][11][12][13][14] a sign of interstitial edema, by using extensive bilateral lung imaging.…”