Lung Ultrasound Score Severity Cut-off Points in COVID-19 Pneumonia. A Systematic Review and Validating Cohort

Overview

Journal Med Clin (Engl Ed)

Date 2023 Jun 20

PMID 37337552

Authors

Jaime Gil-Rodriguez

Michel Martos-Ruiz

Alberto Benavente-Fernandez

Pablo Aranda-Laserna

Miguel Angel Montero-Alonso

Jose-Antonio Peregrina-Rivas

Daniel Fernandez-Reyes

Javier Martinez de Victoria-Carazo

Emilio Guirao-Arrabal

Jose Hernandez-Quero

Affiliations

Soon will be listed here.

Abstract

Objectives: Our purpose was to establish different cut-off points based on the lung ultrasound score (LUS) to classify COVID-19 pneumonia severity.

Methods: Initially, we conducted a systematic review among previously proposed LUS cut-off points. Then, these results were validated by a single-centre prospective cohort study of adult patients with confirmed SARS-CoV-2 infection. Studied variables were poor outcome (ventilation support, intensive care unit admission or 28-days mortality) and 28-days mortality.

Results: From 510 articles, 11 articles were included. Among the cut-off points proposed in the articles included, only the LUS > 15 cut-off point could be validated for its original endpoint, demonstrating also the strongest relation with poor outcome (odds ratio [OR] = 3.636, confidence interval [CI] 1.411-9.374). Regarding our cohort, 127 patients were admitted. In these patients, LUS was statistically associated with poor outcome (OR = 1.303, CI 1.137-1.493), and with 28-days mortality (OR = 1.024, CI 1.006-1.042). LUS > 15 showed the best diagnostic performance when choosing a single cut-off point in our cohort (area under the curve 0.650). LUS ≤ 7 showed high sensitivity to rule out poor outcome (0.89, CI 0.695-0.955), while LUS > 20 revealed high specificity to predict poor outcome (0.86, CI 0.776-0.917).

Conclusions: LUS is a good predictor of poor outcome and 28-days mortality in COVID-19. LUS ≤ 7 cut-off point is associated with mild pneumonia, LUS 8-20 with moderate pneumonia and ≥20 with severe pneumonia. If a single cut-off point were used, LUS > 15 would be the point which better discriminates mild from severe disease.

References

Boero E, Rovida S, Schreiber A, Berchialla P, Charrier L, Cravino M . The COVID-19 Worsening Score (COWS)-a predictive bedside tool for critical illness. Echocardiography. 2021; 38(2):207-216. PMC: 8013873. DOI: 10.1111/echo.14962. View

Ji L, Cao C, Gao Y, Zhang W, Xie Y, Duan Y . Prognostic value of bedside lung ultrasound score in patients with COVID-19. Crit Care. 2020; 24(1):700. PMC: 7754180. DOI: 10.1186/s13054-020-03416-1. View

Smith M, Hayward S, Innes S, Miller A . Point-of-care lung ultrasound in patients with COVID-19 - a narrative review. Anaesthesia. 2020; 75(8):1096-1104. PMC: 7262296. DOI: 10.1111/anae.15082. View

Collins G, Reitsma J, Altman D, Moons K . Transparent Reporting of a multivariable prediction model for Individual Prognosis Or Diagnosis (TRIPOD): the TRIPOD Statement. Br J Surg. 2015; 102(3):148-58. DOI: 10.1002/bjs.9736. View

Song G, Qiao W, Wang X, Yu X . Association of Lung Ultrasound Score with Mortality and Severity of COVID-19: A Meta-Analysis and Trial Sequential Analysis. Int J Infect Dis. 2021; 108:603-609. PMC: 8266421. DOI: 10.1016/j.ijid.2021.06.026. View

Torres-Macho J, Sanchez-Fernandez M, Arnanz-Gonzalez I, Tung-Chen Y, Franco-Moreno A, Duffort-Falco M . Prediction Accuracy of Serial Lung Ultrasound in COVID-19 Hospitalized Patients (Pred-Echovid Study). J Clin Med. 2021; 10(21). PMC: 8584928. DOI: 10.3390/jcm10214818. View

Nouvenne A, Zani M, Milanese G, Parise A, Baciarello M, Bignami E . Lung Ultrasound in COVID-19 Pneumonia: Correlations with Chest CT on Hospital admission. Respiration. 2020; 99(7):617-624. PMC: 7360505. DOI: 10.1159/000509223. View

Ramos Hernandez C, Botana Rial M, Pazos Area L, Nunez Fernandez M, Perez Fernandez S, Rubianes Gonzalez M . [Lung Ultrasound to Predict Unfavorable Progress in Patients Hospitalized for COVID-19]. Arch Bronconeumol. 2021; 57:47-54. PMC: 7505546. DOI: 10.1016/j.arbres.2020.07.043. View

de Alencar J, Marchini J, Marino L, Correa da Costa Ribeiro S, Gasparotto Bueno C, da Cunha V . Lung ultrasound score predicts outcomes in COVID-19 patients admitted to the emergency department. Ann Intensive Care. 2021; 11(1):6. PMC: 7797883. DOI: 10.1186/s13613-020-00799-w. View

10.

Rouby J, Arbelot C, Gao Y, Zhang M, Lv J, An Y . Training for Lung Ultrasound Score Measurement in Critically Ill Patients. Am J Respir Crit Care Med. 2018; 198(3):398-401. PMC: 7205011. DOI: 10.1164/rccm.201802-0227LE. View

11.

Falster C, Jacobsen N, Madsen L, Rasmussen L, Davidsen J, Knudtzen F . Lung ultrasound may be a valuable aid in decision making for patients admitted with COVID-19 disease. Eur Clin Respir J. 2021; 8(1):1909521. PMC: 8032333. DOI: 10.1080/20018525.2021.1909521. View

12.

Ouzzani M, Hammady H, Fedorowicz Z, Elmagarmid A . Rayyan-a web and mobile app for systematic reviews. Syst Rev. 2016; 5(1):210. PMC: 5139140. DOI: 10.1186/s13643-016-0384-4. View

13.

Sumbul H, Koc A, Pinar A, Aslan M, Gulumsek E, Koca H . Modified Lung Ultrasound Score in Evaluating the Severity of Covid-19 Pneumonia. Ultrasound Med Biol. 2021; 47(8):2080-2089. PMC: 8086809. DOI: 10.1016/j.ultrasmedbio.2021.04.023. View

14.

Brahier T, Meuwly J, Pantet O, Brochu Vez M, Gerhard Donnet H, Hartley M . Lung Ultrasonography for Risk Stratification in Patients with Coronavirus Disease 2019 (COVID-19): A Prospective Observational Cohort Study. Clin Infect Dis. 2020; 73(11):e4189-e4196. PMC: 7543331. DOI: 10.1093/cid/ciaa1408. View

15.

Espersen C, Platz E, Skaarup K, Lassen M, Lind J, Johansen N . Lung Ultrasound Findings Associated With COVID-19 ARDS, ICU Admission, and All-Cause Mortality. Respir Care. 2021; 67(1):66-75. PMC: 10408365. DOI: 10.4187/respcare.09108. View

16.

Soldati G, Smargiassi A, Inchingolo R, Buonsenso D, Perrone T, Briganti D . Proposal for International Standardization of the Use of Lung Ultrasound for Patients With COVID-19: A Simple, Quantitative, Reproducible Method. J Ultrasound Med. 2020; 39(7):1413-1419. PMC: 7228287. DOI: 10.1002/jum.15285. View

17.

Trias-Sabria P, Molina-Molina M, Aso S, Argudo M, Diez-Ferrer M, Sabater J . Lung Ultrasound Score to Predict Outcomes in COVID-19. Respir Care. 2021; 66(8):1263-1270. DOI: 10.4187/respcare.08648. View

18.

Lichtenstein D, Meziere G . Relevance of lung ultrasound in the diagnosis of acute respiratory failure: the BLUE protocol. Chest. 2008; 134(1):117-25. PMC: 3734893. DOI: 10.1378/chest.07-2800. View

19.

Lai S, Schafer J, Meinke M, Beals T, Doff M, Grossestreuer A . Lung Ultrasound Score in COVID-19 Patients Correlates with PO/FiO, Intubation Rates, and Mortality. West J Emerg Med. 2024; 25(1):28-39. PMC: 10777190. DOI: 10.5811/westjem.59975. View

20.

Soummer A, Perbet S, Brisson H, Arbelot C, Constantin J, Lu Q . Ultrasound assessment of lung aeration loss during a successful weaning trial predicts postextubation distress*. Crit Care Med. 2012; 40(7):2064-72. DOI: 10.1097/CCM.0b013e31824e68ae. View