Evaluation of a lung ultrasound score in hospitalized adult patients with COVID-19 in Barcelona, Spain

Lightowler, Maria S.; Sander, Julia Verena; García de Casasola Sánchez, Gonzalo; Mateos González, Maria; Güerri Fernández, Roberto; Lorenzo Navarro, Maria Dolores; Nackers, Fabienne; Stratta, Erin; Lanusse, Candelaria; Huerga, Helena

doi:http://dx.doi.org/10.3390/jcm13113282

Evaluation of a lung ultrasound score in hospitalized adult patients with COVID-19 in Barcelona, Spain

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Lightowler MS, Sander JV, García de Casasola Sánchez G, Mateos González M, Güerri-Fernández R, Lorenzo Navarro MD, et al. Evaluation of a lung ultrasound score in hospitalized adult patients with COVID-19 in Barcelona, Spain. J Clin Med. 2024 Jun 2;13(11):3282. DOI: 10.3390/jcm13113282

Abstract

Background/Objectives: During the COVID-19 pandemic and the burden on hospital resources, the rapid categorization of high-risk COVID-19 patients became essential, and lung ultrasound (LUS) emerged as an alternative to chest computed tomography, offering speed, non-ionizing, repeatable, and bedside assessments. Various LUS score systems have been used, yet there is no consensus on an optimal severity cut-off. We assessed the performance of a 12-zone LUS score to identify adult COVID-19 patients with severe lung involvement using oxygen saturation (SpO2)/fractional inspired oxygen (FiO2) ratio as a reference standard to define the best cut-off for predicting adverse outcomes. Methods: We conducted a single-centre prospective study (August 2020-April 2021) at Hospital del Mar, Barcelona, Spain. Upon admission to the general ward or intensive care unit (ICU), clinicians performed LUS in adult patients with confirmed COVID-19 pneumonia. Severe lung involvement was defined as a SpO2/FiO2 ratio <315. The LUS score ranged from 0 to 36 based on the aeration patterns. Results: 248 patients were included. The admission LUS score showed moderate performance in identifying a SpO2/FiO2 ratio <315 (area under the ROC curve: 0.71; 95%CI 0.64-0.77). After adjustment for COVID-19 risk factors, an admission LUS score ≥17 was associated with an increased risk of in-hospital death (OR 5.31; 95%CI: 1.38-20.4), ICU admission (OR 3.50; 95%CI: 1.37-8.94) and need for IMV (OR 3.31; 95%CI: 1.19-9.13). Conclusions: Although the admission LUS score had limited performance in identifying severe lung involvement, a cut-off ≥17 score was associated with an increased risk of adverse outcomes. and could play a role in the rapid categorization of COVID-19 pneumonia patients, anticipating the need for advanced care.