Comparative study of lung ultrasound and chest computed tomography scan in the assessment of severity of confirmed COVID-19 pneumonia

Laurent Zieleskiewicz, Thibaut Markarian, Alexandre Lopez, Chloé Taguet, Neyla Mohammedi, Mohamed Boucekine, Karine Baumstarck, Guillaume Besch, Gautier Mathon, Gary Duclos, Lionel Bouvet, Pierre Michelet, Bernard Allaouchiche, Kathia Chaumoître, Mathieu Di Bisceglie, Marc Leone, AZUREA Network, Laurent Zieleskiewicz, Thibaut Markarian, Alexandre Lopez, Chloé Taguet, Neyla Mohammedi, Mohamed Boucekine, Karine Baumstarck, Guillaume Besch, Gautier Mathon, Gary Duclos, Lionel Bouvet, Pierre Michelet, Bernard Allaouchiche, Kathia Chaumoître, Mathieu Di Bisceglie, Marc Leone, AZUREA Network

Abstract

Purpose: The relationship between lung ultrasound (LUS) and chest computed tomography (CT) scans in patients with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) pneumonia is not clearly defined. The primary objective of our study was to assess the performance of LUS in determining severity of SARS-CoV-2 pneumonia compared with chest CT scan. Secondary objectives were to test the association between LUS score and location of the patient, use of mechanical ventilation, and the pulse oximetry (SpO2)/fractional inspired oxygen (FiO2) ratio.

Methods: A multicentre observational study was performed between 15 March and 20 April 2020. Patients in the Emergency Department (ED) or Intensive Care Unit (ICU) with acute dyspnoea who were PCR positive for SARS-CoV-2, and who had LUS and chest CT performed within a 24-h period, were included.

Results: One hundred patients were included. LUS score was significantly associated with pneumonia severity assessed by chest CT and clinical features. The AUC of the ROC curve of the relationship of LUS versus chest CT for the assessment of severe SARS-CoV-2 pneumonia was 0.78 (CI 95% 0.68-0.87; p < 0.0001). A high LUS score was associated with the use of mechanical ventilation, and with a SpO2/FiO2 ratio below 357.

Conclusion: In known SARS-CoV-2 pneumonia patients, the LUS score was predictive of pneumonia severity as assessed by a chest CT scan and clinical features. Within the limitations inherent to our study design, LUS can be used to assess SARS-CoV-2 pneumonia severity.

Keywords: Chest computed tomography; Diagnostic accuracy; Lung ultrasound; SARS-CoV-2.

Conflict of interest statement

LZ and TM received fees for teaching ultrasound to GE healthcare customers.

Figures

Fig. 1
Fig. 1
Study flowchart
Fig. 2
Fig. 2
Diagnostic accuracy of LUS score for the detection of severe SARS-CoV-2 pneumonia assessed by chest CT scan. a ROC curve of LUS score versus chest CT scan. AUC = 0.78 (CI 95% 0.68–0.87; p < 0.0001), (b) Gray zone of LUS score versus chest CT scan. Solid line: Se (Sensitivity). Dotted line: Sp (Specificity)

References

    1. Li Y, Xia L. Coronavirus disease 2019 (COVID-19): role of chest CT in diagnosis and management. AJR Am J Roentgenol. 2020;1:7. doi: 10.2214/AJR.20.22954.
    1. Ai T, Yang Z, Hou H, et al. Correlation of chest CT and RT-PCR testing in coronavirus disease 2019 (COVID-19) in China: a report of 1014 cases. Radiology. 2020;2:642. doi: 10.1148/radiol.2020200642.
    1. Wu J, Wu X, Zeng W, et al. Chest CT findings in patients with coronavirus disease 2019 and its relationship with clinical features. Invest Radiol. 2020;55:257–261. doi: 10.1097/RLI.0000000000000670.
    1. Mahdjoub E, Mohammad W, Lefevre T, et al. Admission chest CT score predicts 5-day outcome in patients with COVID-19. Intensive Care Med. 2020 doi: 10.1007/s00134-020-06118-y.
    1. Aliaga M, Forel J-M, De Bourmont S, et al. Diagnostic yield and safety of CT scans in ICU. Intensive Care Med. 2015;41:436–443. doi: 10.1007/s00134-014-3592-1.
    1. Jia L, Wang H, Gao Y, et al. High incidence of adverse events during intra-hospital transport of critically ill patients and new related risk factors: a prospective, multicenter study in China. Crit Care. 2016;20:12. doi: 10.1186/s13054-016-1183-y.
    1. Hope MD, Raptis CA, Shah A, et al. A role for CT in COVID-19? What data really tell us so far. Lancet. 2020;395:1189–1190. doi: 10.1016/S0140-6736(20)30728-5.
    1. Lichtenstein D, Goldstein I, Mourgeon E, et al. Comparative diagnostic performances of auscultation, chest radiography, and lung ultrasonography in acute respiratory distress syndrome. Anesthesiology. 2004;100:9–15. doi: 10.1097/00000542-200401000-00006.
    1. Xirouchaki N, Magkanas E, Vaporidi K, et al. Lung ultrasound in critically ill patients: comparison with bedside chest radiography. Intensive Care Med. 2011;37:1488–1493. doi: 10.1007/s00134-011-2317-y.
    1. Staub LJ, Mazzali Biscaro RR, Kaszubowski E, Maurici R. Lung ultrasound for the emergency diagnosis of pneumonia, acute heart failure, and exacerbations of chronic obstructive pulmonary disease/asthma in adults: a systematic review and meta-analysis. J Emerg Med. 2019;56:53–69. doi: 10.1016/j.jemermed.2018.09.009.
    1. Testa A, Soldati G, Copetti R, et al. Early recognition of the 2009 pandemic influenza A (H1N1) pneumonia by chest ultrasound. Crit Care. 2012;16:R30. doi: 10.1186/cc11201.
    1. Buonsenso D, Pata D, Chiaretti A. COVID-19 outbreak: less stethoscope, more ultrasound. Lancet Respir Med. 2020 doi: 10.1016/S2213-2600(20)30120-X.
    1. Lomoro P, Verde F, Zerboni F, et al. COVID-19 pneumonia manifestations at the admission on chest ultrasound, radiographs, and CT: single-center study and comprehensive radiologic literature review. Eur J Radiol Open. 2020;7:100231. doi: 10.1016/j.ejro.2020.100231.
    1. Peng Q-Y, Wang X-T, Zhang L-N, Chinese Critical Care Ultrasound Study Group (CCUSG) Findings of lung ultrasonography of novel corona virus pneumonia during the 2019–2020 epidemic. Intensive Care Med. 2020 doi: 10.1007/s00134-020-05996-6.
    1. Duclos G, Lopez A, Leone M, Zieleskiewicz L. “No dose” lung ultrasound correlation with “low dose” CT scan for early diagnosis of SARS-cov-2 pneumonia. Intensive Care Med. 2020 doi: 10.1007/s00134-020-06058-7.
    1. Toulouse E, Masseguin C, Lafont B, et al. French legal approach to clinical research. Anaesth Crit Care Pain Med. 2018;37:607–614. doi: 10.1016/j.accpm.2018.10.013.
    1. Malas O, Cağlayan B, Fidan A, et al. Cardiac or pulmonary dyspnea in patients admitted to the emergency department. Respir Med. 2003;97:1277–1281. doi: 10.1016/j.rmed.2003.07.002.
    1. Frat J-P, Thille AW, Mercat A, et al. High-flow oxygen through nasal cannula in acute hypoxemic respiratory failure. N Engl J Med. 2015;372:2185–2196. doi: 10.1056/nejmoa1503326.
    1. Pandharipande PP, Shintani AK, Hagerman HE, et al. Derivation and validation of spo2/fio2 ratio to impute for pao2/fio2 ratio in the respiratory component of the Sequential Organ Failure Assessment (SOFA) Score. Crit Care Med. 2009;37:1317–1321. doi: 10.1097/CCM.0b013e31819cefa9.
    1. Mojoli F, Bouhemad B, Mongodi S, Lichtenstein D. Lung ultrasound for critically Ill patients. Am J Respir Crit Care Med. 2018;199:701–714. doi: 10.1164/rccm.201802-0236CI.
    1. Arbelot C, Neto FLD, Gao Y, et al. Lung ultrasound in emergency and critically Ill patientsnumber of supervised exams to reach basic competence. Anesthesiology. 2020;132:899–907. doi: 10.1097/ALN.0000000000003096.
    1. Volpicelli G, Elbarbary M, Blaivas M, et al. International evidence-based recommendations for point-of-care lung ultrasound. Intensive Care Med. 2012;38:577–591. doi: 10.1007/s00134-012-2513-4.
    1. Ray P, Le Manach Y, Riou B, Houle TT. Statistical evaluation of a biomarker. Anesthesiology. 2010;112:1023–1040. doi: 10.1097/ALN.0b013e3181d47604.
    1. Coste J, Pouchot J. A grey zone for quantitative diagnostic and screening tests. Int J Epidemiol. 2003;32:304–313. doi: 10.1093/ije/dyg054.
    1. Zhao W, Zhong Z, Xie X, et al. Relation between chest CT Findings and clinical conditions of coronavirus disease (COVID-19) pneumonia: a multicenter study. Am J Roentgenol. 2020;214:1072–1077. doi: 10.2214/AJR.20.22976.
    1. Rubin GD, Ryerson CJ, Haramati LB, et al. The role of chest imaging in patient management during the COVID-19 pandemic: a multinational consensus statement from the fleischner society. Chest. 2020 doi: 10.1016/j.chest.2020.04.003.
    1. Mayo PH, Copetti R, Feller-Kopman D, et al. Thoracic ultrasonography: a narrative review. Intensive Care Med. 2019;45:1200–1211. doi: 10.1007/s00134-019-05725-8.
    1. Helms J, Tacquard C, Severac F, et al. High risk of thrombosis in patients with severe SARS-cov-2 infection: a multicenter prospective cohort study. Intensive Care Med. 2020;46:1089–1098. doi: 10.1007/s00134-020-06062-x.
    1. Tavazzi G, Civardi L, Caneva L, et al. Thrombotic events in SARS-Cov-2 patients: an urgent call for ultrasound screening. Intensive Care Med. 2020 doi: 10.1007/s00134-020-06040-3.
    1. Koenig S, Chandra S, Alaverdian A, et al. Ultrasound assessment of pulmonary embolism in patients receiving CT pulmonary angiography. Chest. 2014;145:818–823. doi: 10.1378/chest.13-0797.
    1. Nazerian P, Volpicelli G, Gigli C, et al. Diagnostic performance of wells score combined with point-of-care lung and venous ultrasound in suspected pulmonary embolism. Acad Emerg Med. 2017;24:270–280. doi: 10.1111/acem.13130.
    1. Creel-Bulos C, Hockstein M, Amin N, et al. Acute cor pulmonale in critically Ill patients with Covid-19. N Engl J Med. 2020;2:e70. doi: 10.1056/nejmc2010459.
    1. Volpicelli G, Lamorte A, Villén T. What’s new in lung ultrasound during the COVID-19 pandemic. Intensive Care Med. 2020 doi: 10.1007/s00134-020-06048-9.
    1. Markarian T, Zieleskiewicz L, Perrin G, et al. A lung ultrasound score for early triage of elderly patients with acute dyspnea. CJEM. 2019;21:399–405. doi: 10.1017/cem.2018.483.

Source: PubMed

Спонсоры и соавторы

Заболевания

Медикаментозные вмешательства

Подписаться