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Lung ultrasound score severity cut-off points in COVID-19 pneumonia. A systematic review and validating cohort

OBJECTIVES: Our purpose was to establish different cut-off points based on the lung ultrasound score (LUS) to classify COVID-19 pneumonia severity. METHODS: Initially, we conducted a systematic review among previously proposed LUS cut-off points. Then, these results were validated by a single-centre...

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Detalles Bibliográficos
Autores principales: Gil-Rodríguez, Jaime, Martos-Ruiz, Michel, Benavente-Fernández, Alberto, Aranda-Laserna, Pablo, Montero-Alonso, Miguel Ángel, Peregrina-Rivas, José-Antonio, Fernández-Reyes, Daniel, Martínez de Victoria-Carazo, Javier, Guirao-Arrabal, Emilio, Hernández-Quero, José
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Elsevier España, S.L.U. 2023
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9998289/
https://www.ncbi.nlm.nih.gov/pubmed/36990898
http://dx.doi.org/10.1016/j.medcli.2023.01.024
Descripción
Sumario:OBJECTIVES: Our purpose was to establish different cut-off points based on the lung ultrasound score (LUS) to classify COVID-19 pneumonia severity. METHODS: Initially, we conducted a systematic review among previously proposed LUS cut-off points. Then, these results were validated by a single-centre prospective cohort study of adult patients with confirmed SARS-CoV-2 infection. Studied variables were poor outcome (ventilation support, intensive care unit admission or 28-days mortality) and 28-days mortality. RESULTS: From 510 articles, 11 articles were included. Among the cut-off points proposed in the articles included, only the LUS > 15 cut-off point could be validated for its original endpoint, demonstrating also the strongest relation with poor outcome (odds ratio [OR] = 3.636, confidence interval [CI] 1.411–9.374). Regarding our cohort, 127 patients were admitted. In these patients, LUS was statistically associated with poor outcome (OR = 1.303, CI 1.137–1.493), and with 28-days mortality (OR = 1.024, CI 1.006–1.042). LUS > 15 showed the best diagnostic performance when choosing a single cut-off point in our cohort (area under the curve 0.650). LUS ≤ 7 showed high sensitivity to rule out poor outcome (0.89, CI 0.695–0.955), while LUS > 20 revealed high specificity to predict poor outcome (0.86, CI 0.776–0.917). CONCLUSIONS: LUS is a good predictor of poor outcome and 28-days mortality in COVID-19. LUS ≤ 7 cut-off point is associated with mild pneumonia, LUS 8–20 with moderate pneumonia and ≥20 with severe pneumonia. If a single cut-off point were used, LUS > 15 would be the point which better discriminates mild from severe disease.