Findings and Prognostic Value of Lung Ultrasound in COVID ‐19 Pneumonia

  1. Jorge Castelao
  2. Desirée Graziani
  3. Joan B. Soriano
  4. José Luis Izquierdo

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Abstract

The aim of this study was to systematically describe the findings of lung ultrasound (US) in patients with coronavirus 2019 (COVID‐19) pneumonia and to analyze its prognostic value.

Methods

Lung US examinations were performed in 63 patients with COVID‐19 pneumonia admitted to a university hospital. Lung involvement was evaluated on a 4‐point scale with a 12‐area pulmonary division, obtaining a lung score (LS). Ultrasound findings and clinical characteristics were recorded.

Results

All patients showed US involvement in at least 1 area (mean ± SD, 8 ± 3.5). The total LS was 15.3 ± 8.1, without differences between left and right lungs. Most affected regions were the lower region (95.2%) and the posterior region (73.8%). The total LS showed a strong correlation ( r  = −0.765) with the oxygen pressure–to–fraction of inspired oxygen ratio; by lung region, those with a higher correlation were the LS of the anterior region ( r  = −0.823) and the LS of the upper region ( r  = −0.731). In total, 22.2% of patients required noninvasive respiratory support (NIRS). A multivariate analysis showed that the anterior region LS, adjusted for age and sex, was significant (odds ratio, 2.159; 95% confidence interval, 1.309–3.561) for the risk of requiring NIRS. An anterior region LS of 4 or higher and a total LS of 19 or higher had similar characteristics to predict the need for NIRS.

Conclusions

Ultrasound involvement in COVID‐19 pneumonia is bilateral and heterogeneous. Most affected regions are the posterior and the lower regions. The anterior region has prognostic value because its involvement strongly correlates with the risk of requiring NIRS, and an anterior region LS of 4 or higher has high sensitivity and specificity for predicting the need for NIRS.

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  1. Version published to 10.1002/jum.15508
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    SciScore for 10.1101/2020.06.29.20142646: (What is this?)

    Please note, not all rigor criteria are appropriate for all manuscripts.

    Table 1: Rigor

    Institutional Review Board StatementIRB: The project has been approved by the Clinical Research Ethics Committee of the University Hospital of Guadalajara (Spain), and informed consent has been obtained from all patients.
    Consent: The project has been approved by the Clinical Research Ethics Committee of the University Hospital of Guadalajara (Spain), and informed consent has been obtained from all patients.
    Randomizationnot detected.
    Blindingnot detected.
    Power Analysisnot detected.
    Sex as a biological variablenot detected.

    Table 2: Resources

    Software and Algorithms
    SentencesResources
    Statistical analysis has been performed with SPSS for Mac version 26 (IBM, New York, USA).
    SPSS
    suggested: (SPSS, RRID:SCR_002865)

    Results from OddPub: We did not detect open data. We also did not detect open code. Researchers are encouraged to share open data when possible (see Nature blog).

    Results from LimitationRecognizer: An explicit section about the limitations of the techniques employed in this study was not found. We encourage authors to address study limitations.

    Results from TrialIdentifier: No clinical trial numbers were referenced.

    Results from Barzooka: We did not find any issues relating to the usage of bar graphs.

    Results from JetFighter: We did not find any issues relating to colormaps.

    Results from rtransparent:
    • Thank you for including a conflict of interest statement. Authors are encouraged to include this statement when submitting to a journal.
    • Thank you for including a funding statement. Authors are encouraged to include this statement when submitting to a journal.
    • No protocol registration statement was detected.

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  3. Version published to 10.1101/2020.06.29.20142646v1 on medRxiv