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Lightowler MS, Sander JV, García de Casasola Sánchez G, Mateos González M, Güerri-Fernández R, Lorenzo Navarro MD, Nackers F, Stratta E, Lanusse C, Huerga H. Evaluation of a Lung Ultrasound Score in Hospitalized Adult Patients with COVID-19 in Barcelona, Spain. J Clin Med 2024; 13:3282. [PMID: 38892993 PMCID: PMC11172895 DOI: 10.3390/jcm13113282] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2024] [Revised: 05/07/2024] [Accepted: 05/31/2024] [Indexed: 06/21/2024] Open
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.
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Affiliation(s)
| | | | | | | | | | | | | | - Erin Stratta
- Médecins Sans Frontières, New York, NY 10006, USA
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2
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Stoicescu ER, Iacob R, Ilie AC, Iacob ER, Susa SR, Ghenciu LA, Constantinescu A, Cocolea DM, Ciornei-Hoffman A, Oancea C, Manolescu DL. Stratifying Disease Severity in Pediatric COVID-19: A Correlative Study of Serum Biomarkers and Lung Ultrasound-A Retrospective Observational Dual-Center Study. Diagnostics (Basel) 2024; 14:440. [PMID: 38396479 PMCID: PMC10888450 DOI: 10.3390/diagnostics14040440] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2024] [Revised: 02/13/2024] [Accepted: 02/16/2024] [Indexed: 02/25/2024] Open
Abstract
The COVID-19 pandemic, caused by SARS-CoV-2, has manifested distinct impacts on infants and children. This study delves into the intricate connection between lung ultrasound (LUS) findings and serum biomarkers in neonates and infants with COVID-19. Exploring factors contributing to the mild symptoms in this demographic, including immune responses and pre-existing immunity, the study spans 3 years and 9 months, involving 42 patients. Respiratory and gastrointestinal symptoms predominate, and LUS emerges as a vital, non-irradiating tool for evaluating pulmonary abnormalities. Serum biomarkers like CRP, procalcitonin, and cytokines provide key insights into the pathophysiology. Correlations reveal nuanced links between LUS score and clinical parameters, unveiling associations with hospitalization duration (rho = 0.49), oxygen saturation (rho = -0.88), and inflammatory markers, like ferritin (rho = 0.62), LDH (rho = 0.73), and D-dimer (rho = 0.73) with significance level (p < 0.05). The absence of large consolidations in LUS suggests unique pulmonary characteristics. The novelty of these findings lies in the comprehensive integration of LUS with serum biomarkers to assess and monitor the severity of lung involvement in neonates and infants affected by SARS-CoV-2. This approach offers valuable insights into disease severity, biomarker levels, the duration of hospitalization, and oxygen saturation, providing a multifaceted understanding of COVID-19's impact on this vulnerable population.
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Affiliation(s)
- Emil Robert Stoicescu
- Department of Radiology and Medical Imaging, ‘Victor Babes’ University of Medicine and Pharmacy Timisoara, Eftimie Murgu Square No. 2, 300041 Timisoara, Romania; (E.R.S.); (D.L.M.)
- Research Center for Pharmaco-Toxicological Evaluations, ‘Victor Babes’ University of Medicine and Pharmacy Timisoara, Eftimie Murgu Square No. 2, 300041 Timisoara, Romania
- Faculty of Mechanics, Field of Applied Engineering Sciences, Specialization Statistical Methods and Techniques in Health and Clinical Research, ‘Politehnica’ University Timisoara, Mihai Viteazul Boulevard No. 1, 300222 Timisoara, Romania
| | - Roxana Iacob
- Faculty of Mechanics, Field of Applied Engineering Sciences, Specialization Statistical Methods and Techniques in Health and Clinical Research, ‘Politehnica’ University Timisoara, Mihai Viteazul Boulevard No. 1, 300222 Timisoara, Romania
- Department of Anatomy and Embriology, ‘Victor Babes’ University of Medicine and Pharmacy Timisoara, 300041 Timișoara, Romania
- IOSUD/Ph.D. School, ‘Victor Babes’ University of Medicine and Pharmacy Timisoara, Eftimie Murgu Square No. 2, 300041 Timisoara, Romania; (S.R.S.); (A.C.); (D.M.C.)
| | - Adrian Cosmin Ilie
- Department III Functional Sciences, Division of Public Health and Management, “Victor Babes” University of Medicine and Pharmacy, 300041 Timisoara, Romania;
| | - Emil Radu Iacob
- Department of Pediatric Surgery, ‘Victor Babes’ University of Medicine and Pharmacy, Eftimie Murgu Square 2, 300041 Timisoara, Romania;
| | - Septimiu Radu Susa
- IOSUD/Ph.D. School, ‘Victor Babes’ University of Medicine and Pharmacy Timisoara, Eftimie Murgu Square No. 2, 300041 Timisoara, Romania; (S.R.S.); (A.C.); (D.M.C.)
| | - Laura Andreea Ghenciu
- Department of Functional Sciences, ‘Victor Babes’ University of Medicine and Pharmacy Timisoara, Eftimie Murgu Square No. 2, 300041 Timisoara, Romania;
| | - Amalia Constantinescu
- IOSUD/Ph.D. School, ‘Victor Babes’ University of Medicine and Pharmacy Timisoara, Eftimie Murgu Square No. 2, 300041 Timisoara, Romania; (S.R.S.); (A.C.); (D.M.C.)
| | - Daiana Marina Cocolea
- IOSUD/Ph.D. School, ‘Victor Babes’ University of Medicine and Pharmacy Timisoara, Eftimie Murgu Square No. 2, 300041 Timisoara, Romania; (S.R.S.); (A.C.); (D.M.C.)
| | - Andreea Ciornei-Hoffman
- Department of Anatomy and Embryology, Morphological Sciences, ‘Iuliu Hatieganu’ University of Medicine and Pharmacy, 400349 Cluj-Napoca, Romania;
- Department of Radiology and Medical Imaging, County Clinical Emergency Hospital, 400006 Cluj-Napoca, Romania
| | - Cristian Oancea
- Center for Research and Innovation in Precision Medicine of Respiratory Diseases (CRIPMRD), ‘Victor Babeș’ University of Medicine and Pharmacy, 300041 Timișoara, Romania;
- Department of Pulmonology, ‘Victor Babes’ University of Medicine and Pharmacy, 300041 Timisoara, Romania
| | - Diana Luminita Manolescu
- Department of Radiology and Medical Imaging, ‘Victor Babes’ University of Medicine and Pharmacy Timisoara, Eftimie Murgu Square No. 2, 300041 Timisoara, Romania; (E.R.S.); (D.L.M.)
- Center for Research and Innovation in Precision Medicine of Respiratory Diseases (CRIPMRD), ‘Victor Babeș’ University of Medicine and Pharmacy, 300041 Timișoara, Romania;
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3
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Chua MT, Boon Y, Yeoh CK, Li Z, Goh CJM, Kuan WS. Point-of-care ultrasound use in COVID-19: a narrative review. ANNALS OF TRANSLATIONAL MEDICINE 2024; 12:13. [PMID: 38304913 PMCID: PMC10777239 DOI: 10.21037/atm-23-1403] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/22/2023] [Accepted: 06/25/2023] [Indexed: 02/03/2024]
Abstract
Background and Objective The coronavirus disease 2019 (COVID-19) pandemic that began in early 2020 resulted in significant mortality from respiratory tract infections. Existing imaging modalities such as chest X-ray (CXR) lacks sensitivity in its diagnosis while computed tomography (CT) scan carries risks of radiation and contamination. Point-of-care ultrasound (POCUS) has the advantage of bedside testing with higher diagnostic accuracy. We aim to describe the various applications of POCUS for patients with suspected severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) infection in the emergency department (ED) and intensive care unit (ICU). Methods We performed literature search on the use of POCUS in the diagnosis and management of COVID-19 in MEDLINE, Embase and Scopus databases using the following search terms: "ultrasonography", "ultrasound", "COVID-19", "SARS-CoV-2", "SARS-CoV-2 variants", "emergency services", "emergency department" and "intensive care units". Search was performed independently by two reviewers with any discrepancy adjudicated by a third member. Key Content and Findings Lung POCUS in patients with COVID-19 shows different ultrasonographic features from pulmonary oedema, bacterial pneumonia, and other viral pneumonia, thus useful in differentiating between these conditions. It is more sensitive than CXR, and more accessible and widely available than CT scan. POCUS can be used to diagnose COVID-19 pneumonia, screen for COVID-19-related pulmonary and extrapulmonary complications, and guide management of ICU patients, such as timing of ventilator weaning based on lung POCUS findings. Conclusions POCUS is a useful and rapid point-of-care modality that can be used to aid in diagnosis, management, and risk stratification of COVID-19 patients in different healthcare settings.
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Affiliation(s)
- Mui Teng Chua
- Emergency Medicine Department, National University Hospital, National University Health System, Singapore, Singapore
- Department of Surgery, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Yuru Boon
- Emergency Medicine Department, National University Hospital, National University Health System, Singapore, Singapore
- Department of Surgery, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Chew Kiat Yeoh
- Emergency Medicine Department, National University Hospital, National University Health System, Singapore, Singapore
- Department of Surgery, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Zisheng Li
- Emergency Medicine Department, National University Hospital, National University Health System, Singapore, Singapore
- Department of Surgery, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Carmen Jia Man Goh
- Emergency Department, Ng Teng Fong General Hospital, Singapore, Singapore
| | - Win Sen Kuan
- Emergency Medicine Department, National University Hospital, National University Health System, Singapore, Singapore
- Department of Surgery, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
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4
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Lai SY, Schafer JM, Meinke M, Beals T, Doff M, Grossestreuer A, Hoffmann B. Lung Ultrasound Score in COVID-19 Patients Correlates with PO 2/FiO 2, Intubation Rates, and Mortality. West J Emerg Med 2024; 25:28-39. [PMID: 38205982 PMCID: PMC10777190 DOI: 10.5811/westjem.59975] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2023] [Revised: 09/14/2023] [Accepted: 10/19/2023] [Indexed: 01/12/2024] Open
Abstract
Introduction The point-of-care lung ultrasound (LUS) score has been used in coronavirus 2019 (COVID-19) patients for diagnosis and risk stratification, due to excellent sensitivity and infection control concerns. We studied the ratio of partial pressure of oxygen in arterial blood to the fraction of inspiratory oxygen concentration (PO2/FiO2), intubation rates, and mortality correlation to the LUS score. Methods We conducted a systematic review using PRISMA guidelines. Included were articles published from December 1, 2019-November 30, 2021 using LUS in adult COVID-19 patients in the intensive care unit or the emergency department. Excluded were studies on animals and on pediatric and pregnant patients. We assessed bias using QUADAS-2. Outcomes were LUS score and correlation to PO2/FiO2, intubation, and mortality rates. Random effects model pooled the meta-analysis results. Results We reviewed 27 of 5,267 studies identified. Of the 27 studies, seven were included in the intubation outcome, six in the correlation to PO2/FiO2 outcome, and six in the mortality outcome. Heterogeneity was found in ultrasound protocols and outcomes. In the pooled results of 267 patients, LUS score was found to have a strong negative correlation to PO2/FiO2 with a correlation coefficient of -0.69 (95% confidence interval [CI] -0.75, -0.62). In pooled results, 273 intubated patients had a mean LUS score that was 6.95 points higher (95% CI 4.58-9.31) than that of 379 non-intubated patients. In the mortality outcome, 385 survivors had a mean LUS score that was 4.61 points lower (95% CI 3.64-5.58) than that of 181 non-survivors. There was significant heterogeneity between the studies as measured by the I2 and Cochran Q test. Conclusion A higher LUS score was strongly correlated with a decreasing PO2/FiO2 in COVID-19 pneumonia patients. The LUS score was significantly higher in intubated vs non-intubated patients with COVID-19. The LUS score was significantly lower in critically ill patients with COVID-19 pneumonia that survive.
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Affiliation(s)
- Shin-Yi Lai
- Beth Israel Deaconess Medical Center, Department of Emergency Medicine, Boston, Massachusetts
- St Vincent Hospital, Department of Emergency Medicine, Associated Physicians of Harvard Medical Faculty Physicians, Worcester, Massachusetts
| | - Jesse M Schafer
- Beth Israel Deaconess Medical Center, Department of Emergency Medicine, Boston, Massachusetts
| | - Mary Meinke
- Beth Israel Deaconess Medical Center, Department of Emergency Medicine, Boston, Massachusetts
| | - Tyler Beals
- Beth Israel Deaconess Medical Center, Department of Emergency Medicine, Boston, Massachusetts
| | - Michael Doff
- Beth Israel Deaconess Medical Center, Department of Emergency Medicine, Boston, Massachusetts
| | - Anne Grossestreuer
- Beth Israel Deaconess Medical Center, Department of Emergency Medicine, Boston, Massachusetts
| | - Beatrice Hoffmann
- Beth Israel Deaconess Medical Center, Department of Emergency Medicine, Boston, Massachusetts
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Clofent D, Culebras M, Felipe-Montiel A, Arjona-Peris M, Granados G, Sáez M, Pilia F, Ferreiro A, Álvarez A, Loor K, Bosch-Nicolau P, Polverino E. Serial lung ultrasound in monitoring viral pneumonia: the lesson learned from COVID-19. ERJ Open Res 2023; 9:00017-2023. [PMID: 37583967 PMCID: PMC10423983 DOI: 10.1183/23120541.00017-2023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2023] [Accepted: 05/15/2023] [Indexed: 08/17/2023] Open
Abstract
Background Lung ultrasound (LUS) has proven to be useful in the evaluation of lung involvement in COVID-19. However, its effectiveness for predicting the risk of severe disease is still up for debate. The aim of the study was to establish the prognostic accuracy of serial LUS examinations in the prediction of clinical deterioration in hospitalised patients with COVID-19. Methods Prospective single-centre cohort study of patients hospitalised for COVID-19. The study protocol consisted of a LUS examination within 24 h from admission and a follow-up examination on day 3 of hospitalisation. Lung involvement was evaluated by a 14-area LUS score. The primary end-point was the ability of LUS to predict clinical deterioration defined as need for intensive respiratory support with high-flow oxygen or invasive mechanical ventilation. Results 200 patients were included and 35 (17.5%) of them reached the primary end-point and were transferred to the intensive care unit (ICU). The LUS score at admission had been significantly higher in the ICU group than in the non-ICU group (22 (interquartile range (IQR) 20-26) versus 12 (IQR 8-15)). A LUS score at admission ≥17 was shown to be the best cut-off point to discriminate patients at risk of deterioration (area under the curve (AUC) 0.95). The absence of progression in LUS score on day 3 significantly increased the prediction accuracy by ruling out deterioration with a negative predictive value of 99.29%. Conclusion Serial LUS is a reliable tool in predicting the risk of respiratory deterioration in patients hospitalised due to COVID-19 pneumonia. LUS could be further implemented in the future for risk stratification of viral pneumonia.
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Affiliation(s)
- David Clofent
- Department of Respiratory Medicine, Vall d'Hebron University Hospital, Barcelona, Spain
- Vall d'Hebron Institut de Recerca, Barcelona, Spain
- CIBER Enfermedades Respiratorias, Barcelona, Spain
| | - Mario Culebras
- Department of Respiratory Medicine, Vall d'Hebron University Hospital, Barcelona, Spain
- Vall d'Hebron Institut de Recerca, Barcelona, Spain
| | - Almudena Felipe-Montiel
- Department of Respiratory Medicine, Vall d'Hebron University Hospital, Barcelona, Spain
- Vall d'Hebron Institut de Recerca, Barcelona, Spain
| | - Marta Arjona-Peris
- Department of Respiratory Medicine, Vall d'Hebron University Hospital, Barcelona, Spain
- Vall d'Hebron Institut de Recerca, Barcelona, Spain
| | - Galo Granados
- Department of Respiratory Medicine, Vall d'Hebron University Hospital, Barcelona, Spain
- Vall d'Hebron Institut de Recerca, Barcelona, Spain
| | - María Sáez
- Department of Respiratory Medicine, Vall d'Hebron University Hospital, Barcelona, Spain
- Vall d'Hebron Institut de Recerca, Barcelona, Spain
| | - Florencia Pilia
- Department of Respiratory Medicine, Vall d'Hebron University Hospital, Barcelona, Spain
- Vall d'Hebron Institut de Recerca, Barcelona, Spain
| | - Antía Ferreiro
- Department of Respiratory Medicine, Vall d'Hebron University Hospital, Barcelona, Spain
| | - Antonio Álvarez
- Department of Respiratory Medicine, Vall d'Hebron University Hospital, Barcelona, Spain
- Vall d'Hebron Institut de Recerca, Barcelona, Spain
- CIBER Enfermedades Respiratorias, Barcelona, Spain
| | - Karina Loor
- Department of Respiratory Medicine, Vall d'Hebron University Hospital, Barcelona, Spain
- Vall d'Hebron Institut de Recerca, Barcelona, Spain
| | - Pau Bosch-Nicolau
- Vall d'Hebron Institut de Recerca, Barcelona, Spain
- Department of Infectious Diseases, Vall d'Hebron University Hospital, Barcelona, Spain
| | - Eva Polverino
- Department of Respiratory Medicine, Vall d'Hebron University Hospital, Barcelona, Spain
- Vall d'Hebron Institut de Recerca, Barcelona, Spain
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Gil-Rodríguez J, Martos-Ruiz M, Benavente-Fernández A, Aranda-Laserna P, Montero-Alonso MÁ, Peregrina-Rivas JA, Fernández-Reyes D, Martínez de Victoria-Carazo J, Guirao-Arrabal E, Hernández-Quero J. Lung ultrasound score severity cut-off points in COVID-19 pneumonia. A systematic review and validating cohort. Med Clin (Barc) 2023; 160:531-539. [PMID: 36990898 PMCID: PMC9998289 DOI: 10.1016/j.medcli.2023.01.024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2022] [Revised: 01/04/2023] [Accepted: 01/06/2023] [Indexed: 03/12/2023]
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.
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Affiliation(s)
- Jaime Gil-Rodríguez
- Internal Medicine Unit, San Cecilio University Hospital, Avenida del Conocimiento s/n, 18016 Granada, Spain
| | - Michel Martos-Ruiz
- Internal Medicine Unit, San Cecilio University Hospital, Avenida del Conocimiento s/n, 18016 Granada, Spain
| | | | - Pablo Aranda-Laserna
- Internal Medicine Unit, San Cecilio University Hospital, Avenida del Conocimiento s/n, 18016 Granada, Spain
| | - Miguel Ángel Montero-Alonso
- Department of Statistics and Operational Research, University of Granada, Avenida de la Investigación n° 11, 18071 Granada, Spain
| | | | - Daniel Fernández-Reyes
- Internal Medicine Unit, San Cecilio University Hospital, Avenida del Conocimiento s/n, 18016 Granada, Spain
| | | | - Emilio Guirao-Arrabal
- Infectious Diseases Unit, San Cecilio University Hospital, Avenida del Conocimiento s/n, 18016 Granada, Spain.
| | - José Hernández-Quero
- Infectious Diseases Unit, San Cecilio University Hospital, Avenida del Conocimiento s/n, 18016 Granada, Spain
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Gil-Rodríguez J, Martos-Ruiz M, Benavente-Fernández A, Aranda-Laserna P, Montero-Alonso MÁ, Peregrina-Rivas JA, Fernández-Reyes D, Martínez de Victoria-Carazo J, Guirao-Arrabal E, Hernández-Quero J. Lung ultrasound score severity cut-off points in COVID-19 pneumonia. A systematic review and validating cohort. MEDICINA CLINICA (ENGLISH ED.) 2023; 160:531-539. [PMID: 37337552 PMCID: PMC10273011 DOI: 10.1016/j.medcle.2023.01.023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 08/17/2022] [Accepted: 01/06/2023] [Indexed: 06/21/2023]
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.
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Affiliation(s)
- Jaime Gil-Rodríguez
- Internal Medicine Unit, San Cecilio University Hospital, Avenida del Conocimiento s/n, 18016 Granada, Spain
| | - Michel Martos-Ruiz
- Internal Medicine Unit, San Cecilio University Hospital, Avenida del Conocimiento s/n, 18016 Granada, Spain
| | | | - Pablo Aranda-Laserna
- Internal Medicine Unit, San Cecilio University Hospital, Avenida del Conocimiento s/n, 18016 Granada, Spain
| | - Miguel Ángel Montero-Alonso
- Department of Statistics and Operational Research, University of Granada, Avenida de la Investigación n° 11, 18071 Granada, Spain
| | | | - Daniel Fernández-Reyes
- Internal Medicine Unit, San Cecilio University Hospital, Avenida del Conocimiento s/n, 18016 Granada, Spain
| | | | - Emilio Guirao-Arrabal
- Infectious Diseases Unit, San Cecilio University Hospital, Avenida del Conocimiento s/n, 18016 Granada, Spain
| | - José Hernández-Quero
- Infectious Diseases Unit, San Cecilio University Hospital, Avenida del Conocimiento s/n, 18016 Granada, Spain
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8
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Maggi L, De Fazio G, Guglielmi R, Coluzzi F, Fiorelli S, Rocco M. COVID-19 Lung Ultrasound Scores and Lessons from the Pandemic: A Narrative Review. Diagnostics (Basel) 2023; 13:diagnostics13111972. [PMID: 37296825 DOI: 10.3390/diagnostics13111972] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2023] [Revised: 05/30/2023] [Accepted: 06/01/2023] [Indexed: 06/12/2023] Open
Abstract
The WHO recently declared that COVID-19 no longer constitutes a public health emergency of international concern; however, lessons learned through the pandemic should not be left behind. Lung ultrasound was largely utilized as a diagnostic tool thanks to its feasibility, easy application, and the possibility to reduce the source of infection for health personnel. Lung ultrasound scores consist of grading systems used to guide diagnosis and medical decisions, owning a good prognostic value. In the emergency context of the pandemic, several lung ultrasound scores emerged either as new scores or as modifications of pre-existing ones. Our aim is to clarify the key aspects of lung ultrasound and lung ultrasound scores to standardize their clinical use in a non-pandemic context. The authors searched on PubMed for articles related to "COVID-19", "ultrasound", and "Score" until 5 May 2023; other keywords were "thoracic", "lung", "echography", and "diaphragm". A narrative summary of the results was made. Lung ultrasound scores are demonstrated to be an important tool for triage, prediction of severity, and aid in medical decisions. Ultimately, the existence of numerous scores leads to a lack of clarity, confusion, and an absence of standardization.
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Affiliation(s)
- Luigi Maggi
- Government of Italy Ministry of Interior, 00189 Rome, Italy
| | - Giulia De Fazio
- Department of Medical-Surgical Sciences and Translational Medicine, Sapienza University of Rome, 00189 Rome, Italy
| | - Riccardo Guglielmi
- Department of Medical-Surgical Sciences and Translational Medicine, Sapienza University of Rome, 00189 Rome, Italy
| | - Flaminia Coluzzi
- Department of Medical and Surgical Sciences and Biotechnologies, Sapienza University of Rome, 04100 Latina, Italy
- Unit of Anaesthesia, Intensive Care and Pain Medicine, Sant'Andrea University Hospital, 00189 Rome, Italy
| | - Silvia Fiorelli
- Department of Medical-Surgical Sciences and Translational Medicine, Sapienza University of Rome, 00189 Rome, Italy
| | - Monica Rocco
- Department of Medical-Surgical Sciences and Translational Medicine, Sapienza University of Rome, 00189 Rome, Italy
- Unit of Anaesthesia, Intensive Care and Pain Medicine, Sant'Andrea University Hospital, 00189 Rome, Italy
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Torres-Macho J, Casado-Suela MA, Duffort-Falcó M. Lung ultrasound must be the first-line image technique in COVID-19 patients. Eur J Intern Med 2023; 110:21-22. [PMID: 36898935 PMCID: PMC9939398 DOI: 10.1016/j.ejim.2023.02.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/31/2023] [Accepted: 02/16/2023] [Indexed: 02/22/2023]
Affiliation(s)
- Juan Torres-Macho
- Clinical Ultrasound Unit. Internal Medicine Department. Infanta Leonor-Virgen de la Torre University Hospital, Madrid, Spain.
| | - Miguel Angel Casado-Suela
- Clinical Ultrasound Unit. Internal Medicine Department. Infanta Leonor-Virgen de la Torre University Hospital, Madrid, Spain
| | - Mercedes Duffort-Falcó
- Clinical Ultrasound Unit. Internal Medicine Department. Infanta Leonor-Virgen de la Torre University Hospital, Madrid, Spain
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10
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Blazic I, Cogliati C, Flor N, Frija G, Kawooya M, Umbrello M, Ali S, Baranne ML, Cho YJ, Pitcher R, Vollmer I, van Deventer E, del Rosario Perez M. The use of lung ultrasound in COVID-19. ERJ Open Res 2023; 9:00196-2022. [PMID: 36628270 PMCID: PMC9548241 DOI: 10.1183/23120541.00196-2022] [Citation(s) in RCA: 16] [Impact Index Per Article: 16.0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2022] [Accepted: 09/22/2022] [Indexed: 01/13/2023] Open
Abstract
This review article addresses the role of lung ultrasound in patients with coronavirus disease 2019 (COVID-19) for diagnosis and disease management. As a simple imaging procedure, lung ultrasound contributes to the early identification of patients with clinical conditions suggestive of COVID-19, supports decisions about hospital admission and informs therapeutic strategy. It can be performed in various clinical settings (primary care facilities, emergency departments, hospital wards, intensive care units), but also in outpatient settings using portable devices. The article describes typical lung ultrasound findings for COVID-19 pneumonia (interstitial pattern, pleural abnormalities and consolidations), as one component of COVID-19 diagnostic workup that otherwise includes clinical and laboratory evaluation. Advantages and limitations of lung ultrasound use in COVID-19 are described, along with equipment requirements and training needs. To infer on the use of lung ultrasound in different regions, a literature search was performed using key words "COVID-19", "lung ultrasound" and "imaging". Lung ultrasound is a noninvasive, rapid and reproducible procedure; can be performed at the point of care; requires simple sterilisation; and involves non-ionising radiation, allowing repeated exams on the same patient, with special benefit in children and pregnant women. However, physical proximity between the patient and the ultrasound operator is a limitation in the current pandemic context, emphasising the need to implement specific infection prevention and control measures. Availability of qualified staff adequately trained to perform lung ultrasound remains a major barrier to lung ultrasound utilisation. Training, advocacy and awareness rising can help build up capacities of local providers to facilitate lung ultrasound use for COVID-19 management, in particular in low- and middle-income countries.
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Affiliation(s)
- Ivana Blazic
- Radiology Department, Clinical Hospital Center Zemun, Belgrade, Serbia
| | - Chiara Cogliati
- Internal Medicine, L. Sacco Hospital, ASST Fatebenefratelli-Sacco, Milan, Italy
- Department of Biomedical and Clinical Sciences, University of Milan, Milan, Italy
| | - Nicola Flor
- Unità Operativa di Radiologia, Luigi Sacco University Hospital, Milan, Italy
| | - Guy Frija
- Université de Paris, International Society of Radiology, Paris, France
| | - Michael Kawooya
- Ernest Cook Ultrasound Research and Education Institute (ECUREI), Kampala, Uganda
| | - Michele Umbrello
- SC Anestesia e Rianimazione II, Ospedale San Carlo Borromeo, ASST Santi Paolo e Carlo – Polo Universitario, Milan, Italy
| | - Sam Ali
- ECUREI, Mengo Hospital, Kampala, Uganda
| | - Marie-Laure Baranne
- Assistance Publique – Hôpitaux de Paris, Paris Institute for Clinical Ultrasound, Paris, France
| | - Young-Jae Cho
- South Korea/Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Seoul National University College of Medicine, Seoul National University Bundang Hospital, Seoul, South Korea
| | - Richard Pitcher
- Division of Radiodiagnosis, Department of Medical Imaging and Clinical Oncology, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
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11
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Russo G, Flor N, Casella F, Ippolito S, Leidi F, Casazza G, Radovanovic D, Vezzulli F, Santus P, Cogliati C. Lung ultrasound in the follow-up of severe COVID-19 pneumonia: six months evaluation and comparison with CT. Intern Emerg Med 2022; 17:2261-2268. [PMID: 36103083 PMCID: PMC9472735 DOI: 10.1007/s11739-022-03084-9] [Citation(s) in RCA: 15] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/24/2022] [Accepted: 08/16/2022] [Indexed: 12/15/2022]
Abstract
While lung ultrasonography (LUS) proved to be a useful diagnostic and prognostic tool in acute phase of COVID 19 pneumonia, its role in detecting long-term pulmonary sequelae has yet to be explored. In our prospective observational study we assessed the potential of LUS in detecting the presence of computed tomography (CT) fibrotic-like changes after 6 months from COVID-19 pneumonia. Patients who were discharged with a diagnosis of severe COVID-19 pneumonia were enrolled. After 6 months from hospital discharge they underwent LUS, chest CT scan and pulmonary function tests. A logistic regression analysis was performed to assess the association between presence of symptoms, LUS score and diffusing capacity for carbon monoxide (DLCO) at 6-month after hospital discharge and CT scan fibrotic-like changes. A second logistic model was performed to assess the value of some predefined baseline factors (age, sex, worst PaO2/FiO2, ventilator support, worst CRP value, worst D-dimer value and worst LUS score during hospitalization) to predict fibrotic-like changes on 6-month CT scan. Seventy-four patients were enrolled in the study. Twenty-four (32%) showed lung abnormalities suitable for fibrotic-like changes. At multivariate logistic regression analysis LUS score after 6 months from acute disease was significantly associated with fibrotic-like pattern on CT scan. The second logistic model showed that D-dimer value was the only baseline predictive variable of fibrotic-like changes at multivariate analysis. LUS performed after 6 months from severe COVID-19 pneumonia may be a promising tool for detection and follow-up of pulmonary fibrotic sequelae.
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Affiliation(s)
- Giulia Russo
- Internal Medicine, Department of Biomedical and Clinical Sciences, ASST Fatebenefratelli Sacco, University of Milano, Via G.B. Grassi 74, 20157, Milan, Italy.
- Emerging Bacterial Pathogen Unit, Division of Immunology, Transplantation and Infectious Diseases, IRCCS San Raffaele Scientific Institute, Milan, Italy.
| | - Nicola Flor
- Radiology Unit, Ospedale Luigi Sacco, Polo Universitario, ASST Fatebenefratelli-Sacco, Via G.B. Grassi 74, 20157, Milan, Italy
| | - Francesco Casella
- Internal Medicine, Department of Biomedical and Clinical Sciences, ASST Fatebenefratelli Sacco, University of Milano, Via G.B. Grassi 74, 20157, Milan, Italy
| | - Sonia Ippolito
- Radiology Unit, Ospedale Luigi Sacco, Polo Universitario, ASST Fatebenefratelli-Sacco, Via G.B. Grassi 74, 20157, Milan, Italy
| | - Federica Leidi
- Internal Medicine, Department of Biomedical and Clinical Sciences, ASST Fatebenefratelli Sacco, University of Milano, Via G.B. Grassi 74, 20157, Milan, Italy
| | - Giovanni Casazza
- Department of Clinical Sciences and Community Health, Università Degli Studi di Milano, Via Francesco Sforza 35, 20122, Milan, Italy
| | - Dejan Radovanovic
- Division of Respiratory Diseases, Department of Biomedical and Clinical Sciences (DIBIC), Ospedale Luigi Sacco, Polo Universitario, ASST Fatebenefratelli-Sacco, Università Degli Studi di Milano, Via G.B. Grassi 74, 20157, Milan, Italy
| | - Federico Vezzulli
- Internal Medicine, Department of Biomedical and Clinical Sciences, ASST Fatebenefratelli Sacco, University of Milano, Via G.B. Grassi 74, 20157, Milan, Italy
| | - Pierachille Santus
- Division of Respiratory Diseases, Department of Biomedical and Clinical Sciences (DIBIC), Ospedale Luigi Sacco, Polo Universitario, ASST Fatebenefratelli-Sacco, Università Degli Studi di Milano, Via G.B. Grassi 74, 20157, Milan, Italy
| | - Chiara Cogliati
- Internal Medicine, Department of Biomedical and Clinical Sciences, ASST Fatebenefratelli Sacco, University of Milano, Via G.B. Grassi 74, 20157, Milan, Italy
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12
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Lê MP, Jozwiak M, Laghlam D. Current Advances in Lung Ultrasound in COVID-19 Critically Ill Patients: A Narrative Review. J Clin Med 2022; 11:jcm11175001. [PMID: 36078934 PMCID: PMC9457386 DOI: 10.3390/jcm11175001] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2022] [Revised: 08/22/2022] [Accepted: 08/24/2022] [Indexed: 11/16/2022] Open
Abstract
Lung ultrasound (LUS) has a relatively recent democratization due to the better availability and training of physicians, especially in intensive care units. LUS is a relatively cheap and easy-to-learn and -use bedside technique that evaluates pulmonary morphology when using simple algorithms. During the global COVID-19 pandemic, LUS was found to be an accurate tool to quickly diagnose, triage and monitor patients with COVID-19 pneumonia. This paper aims to provide a comprehensive review of LUS use during the COVID-19 pandemic. The first section of our work defines the technique, the practical approach and the semeiotic signs of LUS examination. The second section exposed the COVID-19 pattern in LUS examination and the difference between the differential diagnosis patterns and the well-correlation found with computer tomography scan findings. In the third section, we described the utility of LUS in the management of COVID-19 patients, allowing an early diagnosis and triage in the emergency department, as the monitoring of pneumonia course (pneumonia progression, alveolar recruitment, mechanical ventilation weaning) and detection of secondary complications (pneumothorax, superinfection). Moreover, we describe the usefulness of LUS as a marker of the prognosis of COVID-19 pneumonia in the fourth section. Finally, the 5th part is focused on describing the interest of the LUS, as a non-ionized technique, in the management of pregnant COVID-19 women.
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Affiliation(s)
- Minh Pierre Lê
- Service de Médecine Intensive-Réanimation, Hôpital Cochin, Assistance Publique-Hôpitaux de Paris (AP-HP), Centre & Université Paris Cité, 75014 Paris, France
| | - Mathieu Jozwiak
- Service de Médecine Intensive Réanimation, Centre Hospitalier Universitaire de Nice, Hôpital l’Archet 1, 151 Route Saint Antoine de Ginestière, 06200 Nice, France
- UR2CA, Unité de Recherche Clinique Côte d’Azur, Université Côte d’Azur, 06200 Nice, France
| | - Driss Laghlam
- Service de Médecine Intensive-Réanimation, Hôpital Cochin, Assistance Publique-Hôpitaux de Paris (AP-HP), Centre & Université Paris Cité, 75014 Paris, France
- Correspondence: ; Tel.: +33-158-414-145; Fax: +33-158-412-505
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13
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Flor N, Cogliati C. Monitoring COVID-19 patients in an internal medical ward: chest radiography, chest CT or POCUS? Intern Emerg Med 2022; 17:597-598. [PMID: 34652571 PMCID: PMC8517060 DOI: 10.1007/s11739-021-02861-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/21/2021] [Accepted: 09/26/2021] [Indexed: 01/29/2023]
Affiliation(s)
- Nicola Flor
- Department of Radiology, Luigi Sacco Hospital, Via GB Grassi 74, Milan, Italy.
| | - Chiara Cogliati
- Department of Biomedical Sciences, Internal Medicine, Luigi Sacco Hospital, University of Milan, Milan, Italy
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14
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Espersen C, Platz E, Skaarup KG, Lassen MCH, Lind JN, Johansen ND, Sengeløv M, Alhakak AS, Nielsen AB, Bundgaard H, Hassager C, Jabbari R, Carlsen J, Kirk O, Lindholm MG, Kristiansen OP, Nielsen OW, Jeschke KN, Ulrik CS, Sivapalan P, Gislason G, Iversen K, Jensen JUS, Schou M, Skaarup SH, Biering-Sørensen T. Lung Ultrasound Findings Associated With COVID-19 ARDS, ICU Admission, and All-Cause Mortality. Respir Care 2022; 67:66-75. [PMID: 34815326 PMCID: PMC10408365 DOI: 10.4187/respcare.09108] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
BACKGROUND As lung ultrasound (LUS) has emerged as a diagnostic tool in patients with COVID-19, we sought to investigate the association between LUS findings and the composite in-hospital outcome of ARDS incidence, ICU admission, and all-cause mortality. METHODS In this prospective, multi-center, observational study, adults with laboratory-confirmed SARS-CoV-2 infection were enrolled from non-ICU in-patient units. Subjects underwent an LUS evaluating a total of 8 zones. Images were analyzed off-line, blinded to clinical variables and outcomes. A LUS score was developed to integrate LUS findings: ≥ 3 B-lines corresponded to a score of 1, confluent B-lines to a score of 2, and subpleural or lobar consolidation to a score of 3. The total LUS score ranged from 0-24 per subject. RESULTS Among 215 enrolled subjects, 168 with LUS data and no current signs of ARDS or ICU admission (mean age 59 y, 56% male) were included. One hundred thirty-six (81%) subjects had pathologic LUS findings in ≥ 1 zone (≥ 3 B-lines, confluent B-lines, or consolidations). Markers of disease severity at baseline were higher in subjects with the composite outcome (n = 31, 18%), including higher median C-reactive protein (90 mg/L vs 55, P < .001) and procalcitonin levels (0.35 μg/L vs 0.13, P = .033) and higher supplemental oxygen requirements (median 4 L/min vs 2, P = .001). However, LUS findings and score did not differ significantly between subjects with the composite outcome and those without, and were not associated with outcomes in unadjusted and adjusted logistic regression analyses. CONCLUSIONS Pathologic findings on LUS were common a median of 3 d after admission in this cohort of non-ICU hospitalized subjects with COVID-19 and did not differ among subjects who experienced the composite outcome of incident ARDS, ICU admission, and all-cause mortality compared to subjects who did not. These findings should be confirmed in future investigations. The study is registered at Clinicaltrials.gov (NCT04377035).
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Affiliation(s)
- Caroline Espersen
- Cardiovascular Non-Invasive Imaging Research Laboratory, Department of Cardiology, Herlev and Gentofte Hospital, University of Copenhagen, Copenhagen, Denmark
| | - Elke Platz
- Cardiovascular Division, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Kristoffer Grundtvig Skaarup
- Cardiovascular Non-Invasive Imaging Research Laboratory, Department of Cardiology, Herlev and Gentofte Hospital, University of Copenhagen, Copenhagen, Denmark
| | - Mats Christian Højbjerg Lassen
- Cardiovascular Non-Invasive Imaging Research Laboratory, Department of Cardiology, Herlev and Gentofte Hospital, University of Copenhagen, Copenhagen, Denmark
| | - Jannie Nørgaard Lind
- Cardiovascular Non-Invasive Imaging Research Laboratory, Department of Cardiology, Herlev and Gentofte Hospital, University of Copenhagen, Copenhagen, Denmark
| | - Niklas Dyrby Johansen
- Cardiovascular Non-Invasive Imaging Research Laboratory, Department of Cardiology, Herlev and Gentofte Hospital, University of Copenhagen, Copenhagen, Denmark
| | - Morten Sengeløv
- Cardiovascular Non-Invasive Imaging Research Laboratory, Department of Cardiology, Herlev and Gentofte Hospital, University of Copenhagen, Copenhagen, Denmark
| | - Alia Saed Alhakak
- Cardiovascular Non-Invasive Imaging Research Laboratory, Department of Cardiology, Herlev and Gentofte Hospital, University of Copenhagen, Copenhagen, Denmark
| | - Anne Bjerg Nielsen
- Cardiovascular Non-Invasive Imaging Research Laboratory, Department of Cardiology, Herlev and Gentofte Hospital, University of Copenhagen, Copenhagen, Denmark
| | - Henning Bundgaard
- Department of Cardiology, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
| | - Christian Hassager
- Department of Cardiology, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
| | - Reza Jabbari
- Department of Cardiology, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
| | - Jørn Carlsen
- Department of Cardiology, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
| | - Ole Kirk
- Department of Infectious Diseases, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
| | - Matias Greve Lindholm
- Department of Cardiology, Zealand University Hospital Roskilde, University of Copenhagen, Copenhagen, Denmark
| | - Ole Peter Kristiansen
- Department of Cardiology, Bispebjerg and Frederiksberg Hospital, University of Copenhagen, Copenhagen, Denmark
| | - Olav Wendelboe Nielsen
- Department of Cardiology, Bispebjerg and Frederiksberg Hospital, University of Copenhagen, Copenhagen, Denmark
| | - Klaus Nielsen Jeschke
- Department of Respiratory Medicine, Copenhagen University Hospital-Hvidovre, Hvidovre, Denmark
| | - Charlotte Suppli Ulrik
- Department of Respiratory Medicine, Copenhagen University Hospital-Hvidovre, Hvidovre, Denmark
| | - Pradeesh Sivapalan
- Department of Medicine, Herlev and Gentofte Hospital, University of Copenhagen, Copenhagen, Denmark
| | - Gunnar Gislason
- Cardiovascular Non-Invasive Imaging Research Laboratory, Department of Cardiology, Herlev and Gentofte Hospital, University of Copenhagen, Copenhagen, Denmark
| | - Kasper Iversen
- Cardiovascular Non-Invasive Imaging Research Laboratory, Department of Cardiology, Herlev and Gentofte Hospital, University of Copenhagen, Copenhagen, Denmark
| | - Jens Ulrik Stæhr Jensen
- Department of Medicine, Herlev and Gentofte Hospital, University of Copenhagen, Copenhagen, Denmark
| | - Morten Schou
- Cardiovascular Non-Invasive Imaging Research Laboratory, Department of Cardiology, Herlev and Gentofte Hospital, University of Copenhagen, Copenhagen, Denmark
| | - Søren Helbo Skaarup
- Department of Respiratory Medicine, Aarhus University Hospital, University of Aarhus, Aarhus, Denmark
| | - Tor Biering-Sørensen
- Cardiovascular Non-Invasive Imaging Research Laboratory, Department of Cardiology, Herlev and Gentofte Hospital, University of Copenhagen, Copenhagen, Denmark
- Department of Biomedical Sciences, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
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15
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De Cassai A, Longhini F, Romagnoli S, Cavaliere F, Caroleo A, Foti L, Furlani E, Gianoli S, Monteleone F, Saraco G, Villa G, Conti G, Navalesi P. Research on SARS-COV-2 pandemic: a narrative review focused on the Italian contribution. JOURNAL OF ANESTHESIA, ANALGESIA AND CRITICAL CARE 2021. [PMCID: PMC8596088 DOI: 10.1186/s44158-021-00017-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Abstract
Abstract
Background
Since late 2019, a severe acute respiratory syndrome, caused by the severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2), has spread with overwhelming speed causing over 214 million confirmed infections and more than 4.5 million deaths worldwide. In this framework, Italy had the second highest number of SARS-CoV-2 infections worldwide, and the largest number of deaths. A global effort of both the scientific community and governments has been undertaken to stem the pandemic. The aim of this paper is to perform a narrative review of the Italian contribution to the scientific literature regarding intensive care management of patients suffering from COVID-19, being one of the first western countries to face an outbreak of SARS-CoV-2 infection.
Main body
We performed a narrative review of the literature, dedicating particular attention and a dedicated paragraph to ventilatory support management, chest imaging findings, biomarkers, possible pharmacological interventions, bacterial superinfections, prognosis and non-clinical key aspects such as communication and interaction with relatives.
Conclusions
Many colleagues, nurses and patients died leaving their families alone. To all of them, we send our thoughts and dedicate these pages.
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16
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Gil-Rodríguez J, Martos-Ruiz M, Peregrina-Rivas JA, Aranda-Laserna P, Benavente-Fernández A, Melchor J, Guirao-Arrabal E. Lung Ultrasound, Clinical and Analytic Scoring Systems as Prognostic Tools in SARS-CoV-2 Pneumonia: A Validating Cohort. Diagnostics (Basel) 2021; 11:diagnostics11122211. [PMID: 34943448 PMCID: PMC8699931 DOI: 10.3390/diagnostics11122211] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2021] [Revised: 11/18/2021] [Accepted: 11/22/2021] [Indexed: 11/16/2022] Open
Abstract
At the moment, several COVID-19 scoring systems have been developed. It is necessary to determine which one better predicts a poor outcome of the disease. We conducted a single-center prospective cohort study to validate four COVID-19 prognosis scores in adult patients with confirmed infection at ward. These are National Early Warning Score (NEWS) 2, Lung Ultrasound Score (LUS), COVID-19 Worsening Score (COWS), and Spanish Society of Infectious Diseases and Clinical Microbiology score (SEIMC Score). Our outcomes were the combined variable “poor outcome” (non-invasive mechanical ventilation, intubation, intensive care unit admission, and death at 28 days) and death at 28 days. Scores were analysed using univariate logistic regression models, receiver operating characteristic curves, and areas under the curve. Eighty-one patients were included, from which 21 had a poor outcome, and 9 died. We found a statistically significant correlation between poor outcome and NEWS2, LUS > 15, and COWS. Death at 28 days was statistically correlated with NEWS2 and SEIMC Score although COWS also performs well. NEWS2, LUS, and COWS accurately predict poor outcome; and NEWS2, SEIMC Score, and COWS are useful for anticipating death at 28 days. Lung ultrasound is a diagnostic tool that should be included in COVID-19 patients evaluation.
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Affiliation(s)
- Jaime Gil-Rodríguez
- Internal Medicine Unit, San Cecilio University Hospital, 18012 Granada, Spain; (J.G.-R.); (M.M.-R.); (P.A.-L.); (A.B.-F.)
| | - Michel Martos-Ruiz
- Internal Medicine Unit, San Cecilio University Hospital, 18012 Granada, Spain; (J.G.-R.); (M.M.-R.); (P.A.-L.); (A.B.-F.)
| | | | - Pablo Aranda-Laserna
- Internal Medicine Unit, San Cecilio University Hospital, 18012 Granada, Spain; (J.G.-R.); (M.M.-R.); (P.A.-L.); (A.B.-F.)
| | - Alberto Benavente-Fernández
- Internal Medicine Unit, San Cecilio University Hospital, 18012 Granada, Spain; (J.G.-R.); (M.M.-R.); (P.A.-L.); (A.B.-F.)
| | - Juan Melchor
- Department of Statistics and Operations Research, University of Granada, 18011 Granada, Spain
- Biomechanics Group (TEC-12), Instituto de Investigación Biosanitaria (IBS), 18012 Granada, Spain
- Research Unit “Modelling Nature” (MNat), University of Granada, 18011 Granada, Spain
- Correspondence: (J.M.); (E.G.-A.)
| | - Emilio Guirao-Arrabal
- Infectious Diseases Unit, San Cecilio University Hospital, 18012 Granada, Spain;
- Correspondence: (J.M.); (E.G.-A.)
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17
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Venturelli A, Vitolo M, Albini A, Boriani G. How did COVID-19 affect medical and cardiology journals? A pandemic in literature. J Cardiovasc Med (Hagerstown) 2021; 22:840-847. [PMID: 34482327 PMCID: PMC10100635 DOI: 10.2459/jcm.0000000000001245] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2021] [Revised: 06/28/2021] [Accepted: 08/03/2021] [Indexed: 12/15/2022]
Abstract
BACKGROUND AND AIMS The spreading speed of the COVID-19 pandemic forced the medical community to produce efforts in updating and sharing the evidence about this new disease, trying to preserve the accuracy of the data but at the same time avoiding the potentially harmful delay from discovery to implementation. The aim of our analysis was to assess the impact of the COVID-19 pandemic on medical literature in terms of proportion of COVID-19-related published papers and temporal patterns of publications within a sample of general/internal medicine and cardiology journals. METHODS We searched through PubMed scientific papers published from 1 January 2020 to 31 January 2021 about COVID-19 in ten major medical journals, of which five were in general/internal medicine and five in the cardiology field. We analyzed the proportion of COVID-19-related papers, and we examined temporal trends in the number of published papers. RESULTS Overall, the proportion of COVID-19-related papers was 18.5% (1986/10 756). This proportion was higher among the five selected general/internal medicine journals, compared with cardiology journals (23.8% vs 9.5%). The vast majority of papers were not original articles; in particular, in cardiology journals, there were 28% 'original articles', 17% 'review articles' and 55.1% 'miscellaneous', compared with 20.2%, 5.1% and 74.7% in general/internal medicine journals, respectively. CONCLUSIONS Our analysis highlights the big impact of the COVID-19 pandemic on international scientific literature. General and internal medicine journals were mainly involved, with cardiology journals only at a later time.
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Affiliation(s)
- Andrea Venturelli
- Cardiology Division, Department of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio Emilia, Policlinico di Modena
| | - Marco Vitolo
- Cardiology Division, Department of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio Emilia, Policlinico di Modena
- Clinical and Experimental Medicine PhD Program, University of Modena and Reggio Emilia, Modena, Italy
| | - Alessandro Albini
- Cardiology Division, Department of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio Emilia, Policlinico di Modena
| | - Giuseppe Boriani
- Cardiology Division, Department of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio Emilia, Policlinico di Modena
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18
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Torres-Macho J, Sánchez-Fernández M, Arnanz-González I, Tung-Chen Y, Franco-Moreno AI, Duffort-Falcó M, Beltrán-Romero L, Rodríguez-Suaréz S, Bernabeu-Wittel M, Urbano E, Méndez-Bailon M, Roque-Rojas F, García-Guijarro E, García-Casasola G. Prediction Accuracy of Serial Lung Ultrasound in COVID-19 Hospitalized Patients (Pred-Echovid Study). J Clin Med 2021; 10:jcm10214818. [PMID: 34768337 PMCID: PMC8584928 DOI: 10.3390/jcm10214818] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2021] [Revised: 10/10/2021] [Accepted: 10/16/2021] [Indexed: 12/23/2022] Open
Abstract
The value of serial lung ultrasound (LUS) in patients with COVID-19 is not well defined. In this multicenter prospective observational study, we aimed to assess the prognostic accuracy of serial LUS in patients admitted to hospital due to COVID-19. The serial LUS protocol included two examinations (0–48 h and 72–96 h after admission) using a 10-zones sequence, and a 0 to 5 severity score. Primary combined endpoint was death or the need for invasive mechanical ventilation. Calibration (Hosmer–Lemeshow test and calibration curves), and discrimination power (area under the ROC curve) of both ultrasound exams (SCORE1 and 2), and their difference (DIFFERENTIAL-SCORE) were performed. A total of 469 patients (54.2% women, median age 60 years) were included. The primary endpoint occurred in 51 patients (10.9%). Probability risk tertiles of SCORE1 and SCORE2 (0–11 points, 12–24 points, and ≥25 points) obtained a high calibration. SCORE-2 showed a higher discrimination power than SCORE-1 (AUC 0.72 (0.58–0.85) vs. 0.61 (0.52–0.7)). The DIFFERENTIAL-SCORE showed a higher discrimination power than SCORE-1 and SCORE-2 (AUC 0.78 (0.66–0.9)). An algorithm for clinical decision-making is proposed. Serial lung ultrasound performing two examinations during the first days of hospitalization is an accurate strategy for predicting clinical deterioration of patients with COVID-19.
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Affiliation(s)
- Juan Torres-Macho
- Internal Medicine Department, Infanta Leonor-Virgen de la Torre University Hospital, 28031 Madrid, Spain; (A.I.F.-M.); (M.D.-F.)
- Department of Medicine, School of Medicine, Complutense University, 28040 Madrid, Spain; (I.A.-G.); (M.M.-B.); (G.G.-C.)
- Correspondence:
| | | | - Irene Arnanz-González
- Department of Medicine, School of Medicine, Complutense University, 28040 Madrid, Spain; (I.A.-G.); (M.M.-B.); (G.G.-C.)
- Emergency Department, Infanta Leonor-Virgen de la Torre University Hospital, 28031 Madrid, Spain
| | - Yale Tung-Chen
- Emergency Department, La Paz University Hospital, 28046 Madrid, Spain;
- Enfermera Isabel Zendal Emergency Hospital, 28055 Madrid, Spain
| | - Ana Isabel Franco-Moreno
- Internal Medicine Department, Infanta Leonor-Virgen de la Torre University Hospital, 28031 Madrid, Spain; (A.I.F.-M.); (M.D.-F.)
- Department of Medicine, School of Medicine, Complutense University, 28040 Madrid, Spain; (I.A.-G.); (M.M.-B.); (G.G.-C.)
| | - Mercedes Duffort-Falcó
- Internal Medicine Department, Infanta Leonor-Virgen de la Torre University Hospital, 28031 Madrid, Spain; (A.I.F.-M.); (M.D.-F.)
- Department of Medicine, School of Medicine, Complutense University, 28040 Madrid, Spain; (I.A.-G.); (M.M.-B.); (G.G.-C.)
| | - Luis Beltrán-Romero
- Internal Medicine Department, Virgen del Rocío University Hospital, 41013 Sevilla, Spain; (L.B.-R.); (S.R.-S.); (M.B.-W.)
| | - Santiago Rodríguez-Suaréz
- Internal Medicine Department, Virgen del Rocío University Hospital, 41013 Sevilla, Spain; (L.B.-R.); (S.R.-S.); (M.B.-W.)
| | - Máximo Bernabeu-Wittel
- Internal Medicine Department, Virgen del Rocío University Hospital, 41013 Sevilla, Spain; (L.B.-R.); (S.R.-S.); (M.B.-W.)
| | - Elena Urbano
- Internal Medicine Department, Hospital Clínico San Carlos, 28040 Madrid, Spain;
| | - Manuel Méndez-Bailon
- Department of Medicine, School of Medicine, Complutense University, 28040 Madrid, Spain; (I.A.-G.); (M.M.-B.); (G.G.-C.)
- Internal Medicine Department, Hospital Clínico San Carlos, 28040 Madrid, Spain;
| | - Fernando Roque-Rojas
- Internal Medicine Department, Hospital Universitario Infanta Cristina, 28981 Parla, Madrid, Spain; (F.R.-R.); (E.G.-G.)
| | - Elena García-Guijarro
- Internal Medicine Department, Hospital Universitario Infanta Cristina, 28981 Parla, Madrid, Spain; (F.R.-R.); (E.G.-G.)
| | - Gonzalo García-Casasola
- Department of Medicine, School of Medicine, Complutense University, 28040 Madrid, Spain; (I.A.-G.); (M.M.-B.); (G.G.-C.)
- Internal Medicine Department, Hospital Universitario Infanta Cristina, 28981 Parla, Madrid, Spain; (F.R.-R.); (E.G.-G.)
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19
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Cogliati C, Bosch F, Tung-Chen Y, Smallwood N, Torres-Macho J. Lung ultrasound in COVID-19: Insights from the frontline and research experiences. Eur J Intern Med 2021; 90:19-24. [PMID: 34148715 PMCID: PMC8196300 DOI: 10.1016/j.ejim.2021.06.004] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/01/2021] [Revised: 05/25/2021] [Accepted: 06/05/2021] [Indexed: 12/20/2022]
Affiliation(s)
- Chiara Cogliati
- Internal Medicine, 'L. Sacco' Department of Biomedical and Clinical Sciences, University of Milan, Italy.
| | - Frank Bosch
- Department of Internal Medicine, Radboudumc Nijmegen and Rijnstate Hospital Arnhem, the Netherlands
| | - Yale Tung-Chen
- Internal Medicine Department. Hospital universitario Puerta de Hierro, Majadahonda, Madrid, Spain
| | - Nick Smallwood
- Department of Acute Medicine, East Surrey Hospital, Redhill, UK.
| | - Juan Torres-Macho
- Internal Medicine Department. Infanta Leonor-Virgen de la Torre University Hospital, Madrid, Spain
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