Lung ultrasound score predicts outcomes in COVID-19 patients admitted to the emergency department

Julio Cesar Garcia de Alencar, Julio Flavio Meirelles Marchini, Lucas Oliveira Marino, Sabrina Correa da Costa Ribeiro, Cauê Gasparotto Bueno, Victor Paro da Cunha, Felippe Lazar Neto, Rodrigo Antonio Brandão Neto, Heraldo Possolo Souza, COVID U. S. P. Registry Team, Fernando Salvetti Valente, Hassan Rahhal, Juliana Batista Rodrigues Pereira, Eduardo Messias Hirano Padrão, Annelise Passos Bispos Wanderley, Bruno Marques, Felipe Liger Moreira, Luz Marina Gomez Gomez, Millena Gomes Pinheiro Costa, Lucas de Oliveira Utiyama, Felipe Mouzo Bortoleto, Renan Dourado Tinel, Gabriel Martinez, Saionara Maria Nunes Nascimento, Lucas Gonçalves Dias Barreto, Karina Turaça, Debora Lopes Emerenciano, Daniel Rodrigues Ribeiro, Danilo Dias de Francesco, Eduardo Mariani Pires de Campos, Stefany Franhan Barbosa de Souza, Geovane Wiebelling da Silva, Andrew Araujo Tavares, Clara Carvalho de Alves Pereira, Ademar Lima Simões, Gustavo Biz Martins, Leonardo Antonio Coimbra Moreira, Maria Lorraine Silva de Rosa, Pedro Henrique Rodrigues Santana, Thiago Areas Lisboa Netto, Eduardo Padula, Julio Cesar Leite Fortes, Mauricio Ursoline do Nascimento, Rafael Faria Pisciolaro, Rodolfo Affonso Xavier, Marcel Yukio Kamonseki, Patricia Perez Barroso, Rodolfo Avelino de Souza, Yago Henrique Padovan Chio, Edwin Albert D'Souza, Arthur Petrillo Bellintani, Rodrigo Cezar Miléo, Rodrigo Werner Toccoli, Fernanda Máximo Fonseca E Silva, João Martelleto Baptista, Marcelo de Oliveira Silva, Giovanna Babikian Costa, Rafael Berenguer Luna, Henrique Tibucheski Dos Santos, Mariana Mendes Gonçalves Cimatti De Calasans, Marcelo Petrof Sanches, Diego Juniti Takamune, Luiza Boscolo, Pedro Antonio Araújo Simões, Manuela Cristina Adsuara Pandolfi, Beatriz Larios Fantinatti, Gabriel Travessini, Matheus Finardi Lima de Faria, Ligia Trombetta Lima, Bianca Ruiz Nicolao, Gabriel de Paula Maroni Escudeiro, João Pedro Afonso Nascimento, Bruna Tolentino Caldeira, Laura de Góes Campos, Vitor Macedo Brito Medeiros, Tales Cabral Monsalvarga, Isabela Harumi Omori, Diogo Visconti Guidotte, Alexandre Lemos Bortolotto, Rodrigo de Souza Abreu, Nilo Arthur Bezerra Martins, Carlos Eduardo Umehara Juck, Julio Cesar Garcia de Alencar, Julio Flavio Meirelles Marchini, Lucas Oliveira Marino, Sabrina Correa da Costa Ribeiro, Cauê Gasparotto Bueno, Victor Paro da Cunha, Felippe Lazar Neto, Rodrigo Antonio Brandão Neto, Heraldo Possolo Souza, COVID U. S. P. Registry Team, Fernando Salvetti Valente, Hassan Rahhal, Juliana Batista Rodrigues Pereira, Eduardo Messias Hirano Padrão, Annelise Passos Bispos Wanderley, Bruno Marques, Felipe Liger Moreira, Luz Marina Gomez Gomez, Millena Gomes Pinheiro Costa, Lucas de Oliveira Utiyama, Felipe Mouzo Bortoleto, Renan Dourado Tinel, Gabriel Martinez, Saionara Maria Nunes Nascimento, Lucas Gonçalves Dias Barreto, Karina Turaça, Debora Lopes Emerenciano, Daniel Rodrigues Ribeiro, Danilo Dias de Francesco, Eduardo Mariani Pires de Campos, Stefany Franhan Barbosa de Souza, Geovane Wiebelling da Silva, Andrew Araujo Tavares, Clara Carvalho de Alves Pereira, Ademar Lima Simões, Gustavo Biz Martins, Leonardo Antonio Coimbra Moreira, Maria Lorraine Silva de Rosa, Pedro Henrique Rodrigues Santana, Thiago Areas Lisboa Netto, Eduardo Padula, Julio Cesar Leite Fortes, Mauricio Ursoline do Nascimento, Rafael Faria Pisciolaro, Rodolfo Affonso Xavier, Marcel Yukio Kamonseki, Patricia Perez Barroso, Rodolfo Avelino de Souza, Yago Henrique Padovan Chio, Edwin Albert D'Souza, Arthur Petrillo Bellintani, Rodrigo Cezar Miléo, Rodrigo Werner Toccoli, Fernanda Máximo Fonseca E Silva, João Martelleto Baptista, Marcelo de Oliveira Silva, Giovanna Babikian Costa, Rafael Berenguer Luna, Henrique Tibucheski Dos Santos, Mariana Mendes Gonçalves Cimatti De Calasans, Marcelo Petrof Sanches, Diego Juniti Takamune, Luiza Boscolo, Pedro Antonio Araújo Simões, Manuela Cristina Adsuara Pandolfi, Beatriz Larios Fantinatti, Gabriel Travessini, Matheus Finardi Lima de Faria, Ligia Trombetta Lima, Bianca Ruiz Nicolao, Gabriel de Paula Maroni Escudeiro, João Pedro Afonso Nascimento, Bruna Tolentino Caldeira, Laura de Góes Campos, Vitor Macedo Brito Medeiros, Tales Cabral Monsalvarga, Isabela Harumi Omori, Diogo Visconti Guidotte, Alexandre Lemos Bortolotto, Rodrigo de Souza Abreu, Nilo Arthur Bezerra Martins, Carlos Eduardo Umehara Juck

Abstract

Background: During the COVID-19 pandemic, creating tools to assess disease severity is one of the most important aspects of reducing the burden on emergency departments. Lung ultrasound has a high accuracy for the diagnosis of pulmonary diseases; however, there are few prospective studies demonstrating that lung ultrasound can predict outcomes in COVID-19 patients. We hypothesized that lung ultrasound score (LUS) at hospital admission could predict outcomes of COVID-19 patients. This is a prospective cohort study conducted from 14 March through 6 May 2020 in the emergency department (ED) of an urban, academic, level I trauma center. Patients aged 18 years and older and admitted to the ED with confirmed COVID-19 were considered eligible. Emergency physicians performed lung ultrasounds and calculated LUS, which was tested for correlation with outcomes. This protocol was approved by the local Ethics Committee number 3.990.817 (CAAE: 30417520.0.0000.0068).

Results: The primary endpoint was death from any cause. The secondary endpoints were ICU admission and endotracheal intubation for respiratory failure. Among 180 patients with confirmed COVID-19 who were enrolled (mean age, 60 years; 105 male), the average LUS was 18.7 ± 6.8. LUS correlated with findings from chest CT and could predict the estimated extent of parenchymal involvement (mean LUS with < 50% involvement on chest CT, 15 ± 6.7 vs. 21 ± 6.0 with > 50% involvement, p < 0.001), death (AUC 0.72, OR 1.13, 95% CI 1.07 to 1.21; p < 0.001), endotracheal intubation (AUC 0.76, OR 1.17, 95% CI 1.09 to 1.26; p < 0.001), and ICU admission (AUC: 0.71, OR 1.14, 95% CI 1.07 to 1.21; p < 0.001).

Conclusions: In COVID-19 patients admitted in ED, LUS was a good predictor of death, ICU admission, and endotracheal intubation.

Keywords: COVID-19; Critical care; Emergency medicine; Severe acute respiratory syndrome coronavirus 2; Ultrasonography.

Conflict of interest statement

The authors declare they have no competing interests.

Figures

Fig. 1
Fig. 1
Diagram of patient flow through the study
Fig. 2
Fig. 2
ROC Curves and Outcomes. a For LUS versus all-cause mortality. b For LUS versus endotracheal intubation. c For LUS versus ICU admission

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Source: PubMed

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