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Inicio Medicina Clínica (English Edition) Lung ultrasound score severity cut-off points in COVID-19 pneumonia. A systemati...
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Vol. 160. Issue 12.
Pages 531-539 (June 2023)
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Vol. 160. Issue 12.
Pages 531-539 (June 2023)
Original article
Lung ultrasound score severity cut-off points in COVID-19 pneumonia. A systematic review and validating cohort
Puntos de corte de gravedad del Lung Ultrasound Score en la neumonía COVID-19. Revisión sistemática de la literatura y cohorte de validación
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Jaime Gil-Rodrígueza, Michel Martos-Ruiza, Alberto Benavente-Fernándeza, Pablo Aranda-Lasernaa, Miguel Ángel Montero-Alonsob, José-Antonio Peregrina-Rivasc, Daniel Fernández-Reyesa, Javier Martínez de Victoria-Carazoa, Emilio Guirao-Arrabalc,
Corresponding author
emilio.guirao@gmail.com

Corresponding author.
, José Hernández-Queroc
a Internal Medicine Unit, San Cecilio University Hospital, Avenida del Conocimiento s/n, 18016 Granada, Spain
b Department of Statistics and Operational Research, University of Granada, Avenida de la Investigación n° 11, 18071 Granada, Spain
c Infectious Diseases Unit, San Cecilio University Hospital, Avenida del Conocimiento s/n, 18016 Granada, Spain
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Abstract
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). LUS7 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. LUS7 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.

Keywords:
SARS-CoV-2
COVID-19
Lung
Ultrasound
Disease severity
Mortality
Resumen
Objetivos

Establecer diferentes puntos de corte basados en el Lung Ultrasound Score (LUS) para clasificar la gravedad de la neumonía COVID-19.

Métodos

Inicialmente, realizamos una revisión sistemática entre los puntos de corte LUS propuestos previamente. Estos resultados fueron validados por una cohorte prospectiva unicéntrica de pacientes adultos con infección confirmada por SARS-CoV-2. Las variables analizadas fueron la mala evolución y la mortalidad a los 28 días.

Resultados

De 510 artículos, se incluyeron 11. Entre los puntos de corte propuestos en los artículos incluidos, solo LUS>15 pudo ser validado para su objetivo original, demostrando también la relación más fuerte con mala evolución (odds ratio [OR]=3,636, intervalo de confianza [IC] 1,411-9,374). Respecto a nuestra cohorte, se incluyeron 127 pacientes. En estos pacientes, el LUS se asoció estadísticamente con mala evolución (OR=1,303, IC 1,137-1,493) y con mortalidad a los 28 días (OR=1,024, IC 1,006-1,042). LUS>15 mostró el mejor rendimiento diagnóstico al elegir un único punto de corte en nuestra cohorte (área bajo la curva 0,650). LUS7 mostró una alta sensibilidad para descartar mal resultado (0,89, IC 0,695-0,955), mientras que LUS>20 reveló gran especificidad para predecir mala evolución (0,86, IC 0,776-0,917).

Conclusiones

LUS es un buen predictor de mala evolución y mortalidad a 28 días en COVID-19. LUS7 se asocia con neumonía leve, LUS 8-20 con neumonía moderada y ≥20 con neumonía grave. Si se utilizara un único punto de corte, LUS>15 sería el que mejor discriminaría la enfermedad leve de la grave.

Palabras clave:
SARS-CoV-2
COVID-19
Pulmonar
Ecografía
Gravedad de la enfermedad
Mortalidad

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