Lung ultrasound for the early diagnosis of COVID-19 pneumonia: an international multicenter study

PURPOSE: To analyze the application of a lung ultrasound (LUS)-based diagnostic approach to patients suspected of COVID-19, combining the LUS likelihood of COVID-19 pneumonia with patient’s symptoms and clinical history. METHODS: This is an international multicenter observational study in 20 US and...

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Detalles Bibliográficos
Autores principales: Volpicelli, Giovanni, Gargani, Luna, Perlini, Stefano, Spinelli, Stefano, Barbieri, Greta, Lanotte, Antonella, Casasola, Gonzalo García, Nogué-Bou, Ramon, Lamorte, Alessandro, Agricola, Eustachio, Villén, Tomas, Deol, Paramjeet Singh, Nazerian, Peiman, Corradi, Francesco, Stefanone, Valerio, Fraga, Denise Nicole, Navalesi, Paolo, Ferre, Robinson, Boero, Enrico, Martinelli, Giampaolo, Cristoni, Lorenzo, Perani, Cristiano, Vetrugno, Luigi, McDermott, Cian, Miralles-Aguiar, Francisco, Secco, Gianmarco, Zattera, Caterina, Salinaro, Francesco, Grignaschi, Alice, Boccatonda, Andrea, Giostra, Fabrizio, Infante, Marta Nogué, Covella, Michele, Ingallina, Giacomo, Burkert, Julia, Frumento, Paolo, Forfori, Francesco, Ghiadoni, Lorenzo
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Springer Berlin Heidelberg 2021
Materias:
Original
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7980130/
https://www.ncbi.nlm.nih.gov/pubmed/33743018
http://dx.doi.org/10.1007/s00134-021-06373-7
Descripción
Sumario:PURPOSE: To analyze the application of a lung ultrasound (LUS)-based diagnostic approach to patients suspected of COVID-19, combining the LUS likelihood of COVID-19 pneumonia with patient’s symptoms and clinical history. METHODS: This is an international multicenter observational study in 20 US and European hospitals. Patients suspected of COVID-19 were tested with reverse transcription-polymerase chain reaction (RT-PCR) swab test and had an LUS examination. We identified three clinical phenotypes based on pre-existing chronic diseases (mixed phenotype), and on the presence (severe phenotype) or absence (mild phenotype) of signs and/or symptoms of respiratory failure at presentation. We defined the LUS likelihood of COVID-19 pneumonia according to four different patterns: high (HighLUS), intermediate (IntLUS), alternative (AltLUS), and low (LowLUS) probability. The combination of patterns and phenotypes with RT-PCR results was described and analyzed. RESULTS: We studied 1462 patients, classified in mild (n = 400), severe (n = 727), and mixed (n = 335) phenotypes. HighLUS and IntLUS showed an overall sensitivity of 90.2% (95% CI 88.23–91.97%) in identifying patients with positive RT-PCR, with higher values in the mixed (94.7%) and severe phenotype (97.1%), and even higher in those patients with objective respiratory failure (99.3%). The HighLUS showed a specificity of 88.8% (CI 85.55–91.65%) that was higher in the mild phenotype (94.4%; CI 90.0–97.0%). At multivariate analysis, the HighLUS was a strong independent predictor of RT-PCR positivity (odds ratio 4.2, confidence interval 2.6–6.7, p < 0.0001). CONCLUSION: Combining LUS patterns of probability with clinical phenotypes at presentation can rapidly identify those patients with or without COVID-19 pneumonia at bedside. This approach could support and expedite patients’ management during a pandemic surge. SUPPLEMENTARY INFORMATION: The online version contains supplementary material available at 10.1007/s00134-021-06373-7.

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