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Monitoring of pulmonary involvement in critically ill COVID-19 patients - should lung ultrasound be preferred over CT?
BACKGROUND: It is unclear if relevant changes in pulmonary involvement in critically ill COVID-19 patients can be reliably detected by the CT severity score (CTSS) and lung ultrasound score (LUSS), or if these changes have prognostic implications. In addition, it has been argued that adding pleural...
Autores principales: | , , , , , , , , , , , |
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Formato: | Online Artículo Texto |
Lenguaje: | English |
Publicado: |
Springer International Publishing
2023
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Materias: | |
Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9968403/ https://www.ncbi.nlm.nih.gov/pubmed/36842163 http://dx.doi.org/10.1186/s13089-022-00299-x |
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author | Lieveld, Arthur W. E. Heldeweg, Micah L. A. Schouwenburg, Jasper Veldhuis, Lars Haaksma, Mark E. van Haaften, Rutger M. Teunissen, Berend P. Smit, Jasper M. Twisk, Jos Heunks, Leo Nanayakkara, Prabath W. B. Tuinman, Pieter Roel |
author_facet | Lieveld, Arthur W. E. Heldeweg, Micah L. A. Schouwenburg, Jasper Veldhuis, Lars Haaksma, Mark E. van Haaften, Rutger M. Teunissen, Berend P. Smit, Jasper M. Twisk, Jos Heunks, Leo Nanayakkara, Prabath W. B. Tuinman, Pieter Roel |
author_sort | Lieveld, Arthur W. E. |
collection | PubMed |
description | BACKGROUND: It is unclear if relevant changes in pulmonary involvement in critically ill COVID-19 patients can be reliably detected by the CT severity score (CTSS) and lung ultrasound score (LUSS), or if these changes have prognostic implications. In addition, it has been argued that adding pleural abnormalities to the LUSS could improve its prognostic value. The objective of this study was to compare LUSS and CTSS for the monitoring of COVID-19 pulmonary involvement through: first, establishing the correlation of LUSS (± pleural abnormalities) and CTSS throughout admission; second, assessing agreement and measurement error between raters for LUSS, pleural abnormalities, and CTSS; third, evaluating the association of the LUSS (± pleural abnormalities) and CTSS with mortality at different timepoints. METHODS: This is a prospective, observational study, conducted during the second COVID-19 wave at the AmsterdamUMC, location VUmc. Adult COVID-19 ICU patients were prospectively included when a CT or a 12-zone LUS was performed at admission or at weekly intervals according to local protocol. Patients were followed 90 days or until death. We calculated the: (1) Correlation of the LUSS (± pleural abnormalities) and CTSS throughout admission with mixed models; (2) Intra-class correlation coefficients (ICCs) and smallest detectable changes (SDCs) between raters; (3) Association between the LUSS (± pleural abnormalities) and CTSS with mixed models. RESULTS: 82 consecutive patients were included. Correlation between LUSS and CTSS was 0.45 (95% CI 0.31–0.59). ICCs for LUSS, pleural abnormalities, and CTSS were 0.88 (95% CI 0.73–0.95), 0.94 (95% CI 0.90–0.96), and 0.84 (95% CI 0.65–0.93), with SDCs of 4.8, 1.4, and 3.9. The LUSS was associated with mortality in week 2, with a score difference between patients who survived or died greater than its SDC. Addition of pleural abnormalities was not beneficial. The CTSS was associated with mortality only in week 1, but with a score difference less than its SDC. CONCLUSIONS: LUSS correlated with CTSS throughout ICU admission but performed similar or better at agreement between raters and mortality prognostication. Given the benefits of LUS over CT, it should be preferred as initial monitoring tool. SUPPLEMENTARY INFORMATION: The online version contains supplementary material available at 10.1186/s13089-022-00299-x. |
format | Online Article Text |
id | pubmed-9968403 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2023 |
publisher | Springer International Publishing |
record_format | MEDLINE/PubMed |
spelling | pubmed-99684032023-02-28 Monitoring of pulmonary involvement in critically ill COVID-19 patients - should lung ultrasound be preferred over CT? Lieveld, Arthur W. E. Heldeweg, Micah L. A. Schouwenburg, Jasper Veldhuis, Lars Haaksma, Mark E. van Haaften, Rutger M. Teunissen, Berend P. Smit, Jasper M. Twisk, Jos Heunks, Leo Nanayakkara, Prabath W. B. Tuinman, Pieter Roel Ultrasound J Original Article BACKGROUND: It is unclear if relevant changes in pulmonary involvement in critically ill COVID-19 patients can be reliably detected by the CT severity score (CTSS) and lung ultrasound score (LUSS), or if these changes have prognostic implications. In addition, it has been argued that adding pleural abnormalities to the LUSS could improve its prognostic value. The objective of this study was to compare LUSS and CTSS for the monitoring of COVID-19 pulmonary involvement through: first, establishing the correlation of LUSS (± pleural abnormalities) and CTSS throughout admission; second, assessing agreement and measurement error between raters for LUSS, pleural abnormalities, and CTSS; third, evaluating the association of the LUSS (± pleural abnormalities) and CTSS with mortality at different timepoints. METHODS: This is a prospective, observational study, conducted during the second COVID-19 wave at the AmsterdamUMC, location VUmc. Adult COVID-19 ICU patients were prospectively included when a CT or a 12-zone LUS was performed at admission or at weekly intervals according to local protocol. Patients were followed 90 days or until death. We calculated the: (1) Correlation of the LUSS (± pleural abnormalities) and CTSS throughout admission with mixed models; (2) Intra-class correlation coefficients (ICCs) and smallest detectable changes (SDCs) between raters; (3) Association between the LUSS (± pleural abnormalities) and CTSS with mixed models. RESULTS: 82 consecutive patients were included. Correlation between LUSS and CTSS was 0.45 (95% CI 0.31–0.59). ICCs for LUSS, pleural abnormalities, and CTSS were 0.88 (95% CI 0.73–0.95), 0.94 (95% CI 0.90–0.96), and 0.84 (95% CI 0.65–0.93), with SDCs of 4.8, 1.4, and 3.9. The LUSS was associated with mortality in week 2, with a score difference between patients who survived or died greater than its SDC. Addition of pleural abnormalities was not beneficial. The CTSS was associated with mortality only in week 1, but with a score difference less than its SDC. CONCLUSIONS: LUSS correlated with CTSS throughout ICU admission but performed similar or better at agreement between raters and mortality prognostication. Given the benefits of LUS over CT, it should be preferred as initial monitoring tool. SUPPLEMENTARY INFORMATION: The online version contains supplementary material available at 10.1186/s13089-022-00299-x. Springer International Publishing 2023-02-26 /pmc/articles/PMC9968403/ /pubmed/36842163 http://dx.doi.org/10.1186/s13089-022-00299-x Text en © The Author(s) 2023 https://creativecommons.org/licenses/by/4.0/Open AccessThis article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/ (https://creativecommons.org/licenses/by/4.0/) . |
spellingShingle | Original Article Lieveld, Arthur W. E. Heldeweg, Micah L. A. Schouwenburg, Jasper Veldhuis, Lars Haaksma, Mark E. van Haaften, Rutger M. Teunissen, Berend P. Smit, Jasper M. Twisk, Jos Heunks, Leo Nanayakkara, Prabath W. B. Tuinman, Pieter Roel Monitoring of pulmonary involvement in critically ill COVID-19 patients - should lung ultrasound be preferred over CT? |
title | Monitoring of pulmonary involvement in critically ill COVID-19 patients - should lung ultrasound be preferred over CT? |
title_full | Monitoring of pulmonary involvement in critically ill COVID-19 patients - should lung ultrasound be preferred over CT? |
title_fullStr | Monitoring of pulmonary involvement in critically ill COVID-19 patients - should lung ultrasound be preferred over CT? |
title_full_unstemmed | Monitoring of pulmonary involvement in critically ill COVID-19 patients - should lung ultrasound be preferred over CT? |
title_short | Monitoring of pulmonary involvement in critically ill COVID-19 patients - should lung ultrasound be preferred over CT? |
title_sort | monitoring of pulmonary involvement in critically ill covid-19 patients - should lung ultrasound be preferred over ct? |
topic | Original Article |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9968403/ https://www.ncbi.nlm.nih.gov/pubmed/36842163 http://dx.doi.org/10.1186/s13089-022-00299-x |
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