TY - JOUR

T1 - Focused lung ultrasound to predict respiratory failure in patients with symptoms of COVID-19

T2 - a multicentre prospective cohort study

AU - Skaarup, Søren Helbo

AU - Aagaard, Rasmus

AU - Ovesen, Stig Holm

AU - Kirkegaard, Jesper Weile Hans

AU - Espersen, Caroline

AU - Lassen, Mats Christian Højbjerg

AU - Skaarup, Kristoffer Grundtvig

AU - Posth, Stefan

AU - Laursen, Christian B.

AU - Bock, Ask

AU - Arvig, Michael Dan

AU - Biering-Sørensen, Tor

N1 - Funding Information: We thank Bo Bibby (Department of Biostatistics, Public Health, Aarhus University, Denmark) for statistical support.Support statement: The trial was sponsored by the Poul Due Jensens Foundation. The sponsors had no role in designing the study or in the collection, management, analysis or interpretation of the data, nor in writing of the manuscript. Together with K.G. Skaarup and M.C.H. Lassen, T. Biering-Sørensen received a research grant from the Novo Nordisk Foundation to conduct part of this study. Europcar Denmark provided cars for K.G. Skaarup and M.C.H. Lassen to transport the equipment from hospital to hospital. T. Biering-Sørensen received funds from Herlev and Gentofte Hospital and the Lundbeck Foundation while conducting part of this study. Funding Information: Support statement: The trial was sponsored by the Poul Due Jensens Foundation. The sponsors had no role in designing the study or in the collection, management, analysis or interpretation of the data, nor in writing of the manuscript. Together with K.G. Skaarup and M.C.H. Lassen, T. Biering-Sørensen received a research grant from the Novo Nordisk Foundation to conduct part of this study. Europcar Denmark provided cars for K.G. Skaarup and M.C.H. Lassen to transport the equipment from hospital to hospital. T. Biering-Sørensen received funds from Herlev and Gentofte Hospital and the Lundbeck Foundation while conducting part of this study. Publisher Copyright: © The authors 2022.

PY - 2022

Y1 - 2022

N2 - Background In this study we aimed to assess if a focused lung ultrasound examination predicts the need for mechanical ventilation, admission to an intensive care unit, high-flow oxygen treatment, death from COVID-19 within 30 days and 30-day all-cause mortality in patients with clinical suspicion of COVID-19 or PCR-verified SARS-CoV-2 infection. Methods A multicentre prospective cohort trial was performed. Film clips from focused lung ultrasound examinations were recorded and rated by blinded observers using different scoring systems. A prediction model was built and used to test relationship between lung ultrasound scores and clinical outcomes. Diagnostic performance of scoring systems was analysed. Results A total of 3889 film clips of 398 patients were analysed. Patients who had any of the outcomes of interest had a significantly higher ultrasound score than those who did not. Multivariable logistic regression analyses showed that lung ultrasound predicts mechanical ventilation (relative risk 2.44, 95% CI 1.32–5.52), admission to intensive care (relative risk 2.55, 95% CI 1.41–54.59) and high-flow oxygen treatment (relative risk 1.95, 95% CI 1.5–2.53) but not survival when adjusting for sex, age and relevant comorbidity. There was no diagnostic difference in area under the receiver operating characteristic curve between a scoring system using only anterolateral thorax zones and a scoring system that also included dorsal zones. Conclusion Focused lung ultrasound in patients with clinical suspicion of COVID-19 predicts respiratory failure requiring mechanical ventilation, admission to intensive care units and the need for high-flow oxygen treatment. Thus, focused lung ultrasound may be used to risk stratify patients with COVID-19 symptoms.

AB - Background In this study we aimed to assess if a focused lung ultrasound examination predicts the need for mechanical ventilation, admission to an intensive care unit, high-flow oxygen treatment, death from COVID-19 within 30 days and 30-day all-cause mortality in patients with clinical suspicion of COVID-19 or PCR-verified SARS-CoV-2 infection. Methods A multicentre prospective cohort trial was performed. Film clips from focused lung ultrasound examinations were recorded and rated by blinded observers using different scoring systems. A prediction model was built and used to test relationship between lung ultrasound scores and clinical outcomes. Diagnostic performance of scoring systems was analysed. Results A total of 3889 film clips of 398 patients were analysed. Patients who had any of the outcomes of interest had a significantly higher ultrasound score than those who did not. Multivariable logistic regression analyses showed that lung ultrasound predicts mechanical ventilation (relative risk 2.44, 95% CI 1.32–5.52), admission to intensive care (relative risk 2.55, 95% CI 1.41–54.59) and high-flow oxygen treatment (relative risk 1.95, 95% CI 1.5–2.53) but not survival when adjusting for sex, age and relevant comorbidity. There was no diagnostic difference in area under the receiver operating characteristic curve between a scoring system using only anterolateral thorax zones and a scoring system that also included dorsal zones. Conclusion Focused lung ultrasound in patients with clinical suspicion of COVID-19 predicts respiratory failure requiring mechanical ventilation, admission to intensive care units and the need for high-flow oxygen treatment. Thus, focused lung ultrasound may be used to risk stratify patients with COVID-19 symptoms.

UR - http://www.scopus.com/inward/record.url?scp=85141169796&partnerID=8YFLogxK

U2 - 10.1183/23120541.00128-2022

DO - 10.1183/23120541.00128-2022

M3 - Journal article

C2 - 36284826

AN - SCOPUS:85141169796

VL - 8

JO - ERJ Open Research

JF - ERJ Open Research

SN - 2312-0541

IS - 4

M1 - 00128-2022

ER -