Poor lung ultrasound score in shock patients admitted to the ICU is associated with worse outcome

Wanhong Yin, Tongjuan Zou, Yao Qin, Jing Yang, Yi Li, Xueying Zeng, Yan Kang, Chinese Critical Ultrasound Study Group (CCUSG), Wanhong Yin, Tongjuan Zou, Yao Qin, Jing Yang, Yi Li, Xueying Zeng, Yan Kang, Chinese Critical Ultrasound Study Group (CCUSG)

Abstract

Background: The lung ultrasound score has been regarded as a decent semiquantitative score to measure the lung aeration loss. The score has been proven to be valuable in diagnosing and monitoring lung pathology, but no studies have demonstrated its relationship to the outcome. We aimed to investigate the relationship between the lung ultrasound score and outcome in shock patients in the Intensive Care Unit.

Methods: The data were extracted from the SHOCK-ICU study, a 14-month prospective study of shock patients in the Medical Intensive Care Unit in West China Hospital. A bivariate logistic regression model was established to identify the correlation between the lung ultrasound score on admission and the 28-day mortality. For subsequent analyses, we divided patients into lung ultrasound score quartiles, and survival analysis was performed using Cox stratified survival analysis and regression analysis with the Breslow method of ties.

Results: A total of 175 cases with a completed lung ultrasound exam were included. The mean APACHE II score was 23.7 ± 8.8, and the 28-day mortality was 46.3% (81/175). The multivariate analysis demonstrated that the lung ultrasound score was an independent risk factor for 28-day mortality, as well as the APACHE II score and lactate level. When divided into lung ultrasound score quartiles, after correcting for the APACHE II score, vasoactive use, PaO2/FiO2, and lactate level, the COX analysis reveals that a higher lung ultrasound score was related to a lower survival rate. Quartile 1 and quartile 2 had a significantly lower hazard ratio versus quartile 4 (OR 0.442[0.215-0.911]; 0.484[0.251-0.934], respectively).

Conclusions: The lung ultrasound score is independently related to the 28-day mortality, as well as the APACHE II score and lactate level, in Intensive Care Unit shock patients. A higher elevated lung ultrasound score on admission is associated with a worse outcome.

Trial registration: The study is registered on Clinical Trials.

Trial registration: NCT03082326 ; retrospectively registered on 3 March 2017.

Keywords: Critical care ultrasound; ICU; Lung ultrasound score; Prognosis; Shock.

Conflict of interest statement

Ethics approval and consent to participate

The study was approved by the ethics committee of West China Hospital review board for human research:2017(200). Since the critical care ultrasound examination was harmless and has been applied as a routine estimation on patients’ admission in our MICU, the committee approved the researchers to obtain verbal consent from all patients or the patients’ next of kin (when patients were intubated or unconscious) to consent this study.

Consent for publication

Not applicable.

Competing interests

The authors declare that they have no competing interests.

Publisher’s Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Figures

Fig. 1
Fig. 1
Eight-zone lung ultrasound examination protocol and lung ultrasound pattern. A: Each hemithorax is separated into four quadrants: anterior and lateral zones (separated by the anterior axillary lines) with each one divided into upper and lower portions. AAL indicates the anterior axillary line. B: Lung ultrasound pattern. (a): A pattern; (b): B1 pattern; (c): B2 pattern; (d): C pattern (lung consolidation).
Fig. 2
Fig. 2
Survival analysis for the four LUSS quartiles. After correcting for PaO2/ FiO2, the APACHE II score, vasoactive use and lactate, the survival analysis reveals that a higher LUSS was related to a lower survival rate.

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