tetano
Editor, Senior Moderator
Respiration
. 2021 Aug 31;1-10.
doi: 10.1159/000518516. Online ahead of print.
Prognostic Significance of Chest Imaging by LUS and CT in COVID-19 Inpatients: The ECOVID Multicenter Study
Claudio Tana[SUP] 1 [/SUP], Fabrizio Ricci[SUP] 2 3 4 [/SUP], Maria Gabriella Coppola[SUP] 5 [/SUP], Cesare Mantini[SUP] 2 [/SUP], Fulvio Lauretani[SUP] 6 7 [/SUP], Daniele Campanozzi[SUP] 8 [/SUP], Giulia Renda[SUP] 2 [/SUP], Sabina Gallina[SUP] 2 [/SUP], Marina Lugará[SUP] 5 [/SUP], Francesco Cipollone[SUP] 9 [/SUP], Maria Adele Giamberardino[SUP] 10 [/SUP], Luciano Mucci[SUP] 8 [/SUP]
Affiliations
Abstract
Background: Point-of-care lung ultrasound (LUS) score is a semiquantitative score of lung damage severity. High-resolution computed tomography (HRCT) is the gold standard method to evaluate the severity of lung involvement from the novel coronavirus disease (COVID-19). Few studies have investigated the clinical significance of LUS and HRCT scores in patients with COVID-19. Therefore, the aim of this study was to evaluate the prognostic yield of LUS and of HRCT in COVID-19 patients.
Methods: We carried out a multicenter, retrospective study aimed at evaluating the prognostic yield of LUS and HRCT by exploring the survival curve of COVID-19 inpatients. LUS and chest CT scores were calculated retrospectively by 2 radiologists with >10 years of experience in chest imaging, and the decisions were reached in consensus. LUS score was calculated on the basis of the presence or not of pleural line abnormalities, B-lines, and lung consolidations. The total score (range 0-36) was obtained from the sum of the highest scores obtained in each region. CT score was calculated for each of the 5 lobes considering the anatomical extension according to the percentage parenchymal involvement. The resulting overall global semiquantitative CT score was the sum of each single lobar score and ranged from 0 (no involvement) to 25 (maximum involvement).
Results: One hundred fifty-three COVID-19 inpatients (mean age 65 ± 15 years; 65% M), including 23 (15%) in-hospital deaths for any cause over a mean follow-up of 14 days were included. Mean LUS and CT scores were 19 ± 12 and 10 ± 7, respectively. A strong positive linear correlation between LUS and CT scores (Pearson correlation r = 0.754; R2 = 0.568; p < 0.001) was observed. By ROC curve analysis, the optimal cut-point for mortality prediction was 20 for LUS score and 4.5 for chest CT score. According to Kaplan-Meier survival analysis, in-hospital mortality significantly increased among COVID-19 patients presenting with an LUS score ≥20 (log-rank 0.003; HR 9.87, 95% CI: 2.22-43.83) or a chest CT score ≥4.5 (HR 4.34, 95% CI: 0.97-19.41). At multivariate Cox regression analysis, LUS score was the sole independent predictor of in-hospital mortality yielding an adjusted HR of 7.42 (95% CI: 1.59-34.5).
Conclusion: LUS score is useful to stratify the risk in COVID-19 patients, predicting those that are at high risk of mortality.
Keywords: Computed tomography; Coronavirus disease 2019; Lung ultrasound; Lung ultrasound score; Mortality.
. 2021 Aug 31;1-10.
doi: 10.1159/000518516. Online ahead of print.
Prognostic Significance of Chest Imaging by LUS and CT in COVID-19 Inpatients: The ECOVID Multicenter Study
Claudio Tana[SUP] 1 [/SUP], Fabrizio Ricci[SUP] 2 3 4 [/SUP], Maria Gabriella Coppola[SUP] 5 [/SUP], Cesare Mantini[SUP] 2 [/SUP], Fulvio Lauretani[SUP] 6 7 [/SUP], Daniele Campanozzi[SUP] 8 [/SUP], Giulia Renda[SUP] 2 [/SUP], Sabina Gallina[SUP] 2 [/SUP], Marina Lugará[SUP] 5 [/SUP], Francesco Cipollone[SUP] 9 [/SUP], Maria Adele Giamberardino[SUP] 10 [/SUP], Luciano Mucci[SUP] 8 [/SUP]
Affiliations
- PMID: 34515247
- DOI: 10.1159/000518516
Abstract
Background: Point-of-care lung ultrasound (LUS) score is a semiquantitative score of lung damage severity. High-resolution computed tomography (HRCT) is the gold standard method to evaluate the severity of lung involvement from the novel coronavirus disease (COVID-19). Few studies have investigated the clinical significance of LUS and HRCT scores in patients with COVID-19. Therefore, the aim of this study was to evaluate the prognostic yield of LUS and of HRCT in COVID-19 patients.
Methods: We carried out a multicenter, retrospective study aimed at evaluating the prognostic yield of LUS and HRCT by exploring the survival curve of COVID-19 inpatients. LUS and chest CT scores were calculated retrospectively by 2 radiologists with >10 years of experience in chest imaging, and the decisions were reached in consensus. LUS score was calculated on the basis of the presence or not of pleural line abnormalities, B-lines, and lung consolidations. The total score (range 0-36) was obtained from the sum of the highest scores obtained in each region. CT score was calculated for each of the 5 lobes considering the anatomical extension according to the percentage parenchymal involvement. The resulting overall global semiquantitative CT score was the sum of each single lobar score and ranged from 0 (no involvement) to 25 (maximum involvement).
Results: One hundred fifty-three COVID-19 inpatients (mean age 65 ± 15 years; 65% M), including 23 (15%) in-hospital deaths for any cause over a mean follow-up of 14 days were included. Mean LUS and CT scores were 19 ± 12 and 10 ± 7, respectively. A strong positive linear correlation between LUS and CT scores (Pearson correlation r = 0.754; R2 = 0.568; p < 0.001) was observed. By ROC curve analysis, the optimal cut-point for mortality prediction was 20 for LUS score and 4.5 for chest CT score. According to Kaplan-Meier survival analysis, in-hospital mortality significantly increased among COVID-19 patients presenting with an LUS score ≥20 (log-rank 0.003; HR 9.87, 95% CI: 2.22-43.83) or a chest CT score ≥4.5 (HR 4.34, 95% CI: 0.97-19.41). At multivariate Cox regression analysis, LUS score was the sole independent predictor of in-hospital mortality yielding an adjusted HR of 7.42 (95% CI: 1.59-34.5).
Conclusion: LUS score is useful to stratify the risk in COVID-19 patients, predicting those that are at high risk of mortality.
Keywords: Computed tomography; Coronavirus disease 2019; Lung ultrasound; Lung ultrasound score; Mortality.