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. 2021 Oct 20;10(21):4818.
doi: 10.3390/jcm10214818.

Prediction Accuracy of Serial Lung Ultrasound in COVID-19 Hospitalized Patients (Pred-Echovid Study)

Juan Torres-Macho  1   2 , Marcos Sánchez-Fernández  3 , Irene Arnanz-González  2   4 , Yale Tung-Chen  5   6 , Ana Isabel Franco-Moreno  1   2 , Mercedes Duffort-Falcó  1   2 , Luis Beltrán-Romero  7 , Santiago Rodríguez-Suaréz  7 , Máximo Bernabeu-Wittel  7 , Elena Urbano  8 , Manuel Méndez-Bailon  2   8 , Fernando Roque-Rojas  9 , Elena García-Guijarro  9 , Gonzalo García-Casasola  2   9
Affiliations

Prediction Accuracy of Serial Lung Ultrasound in COVID-19 Hospitalized Patients (Pred-Echovid Study)

Juan Torres-Macho et al. J Clin Med. .

Abstract

The value of serial lung ultrasound (LUS) in patients with COVID-19 is not well defined. In this multicenter prospective observational study, we aimed to assess the prognostic accuracy of serial LUS in patients admitted to hospital due to COVID-19. The serial LUS protocol included two examinations (0-48 h and 72-96 h after admission) using a 10-zones sequence, and a 0 to 5 severity score. Primary combined endpoint was death or the need for invasive mechanical ventilation. Calibration (Hosmer-Lemeshow test and calibration curves), and discrimination power (area under the ROC curve) of both ultrasound exams (SCORE1 and 2), and their difference (DIFFERENTIAL-SCORE) were performed. A total of 469 patients (54.2% women, median age 60 years) were included. The primary endpoint occurred in 51 patients (10.9%). Probability risk tertiles of SCORE1 and SCORE2 (0-11 points, 12-24 points, and ≥25 points) obtained a high calibration. SCORE-2 showed a higher discrimination power than SCORE-1 (AUC 0.72 (0.58-0.85) vs. 0.61 (0.52-0.7)). The DIFFERENTIAL-SCORE showed a higher discrimination power than SCORE-1 and SCORE-2 (AUC 0.78 (0.66-0.9)). An algorithm for clinical decision-making is proposed. Serial lung ultrasound performing two examinations during the first days of hospitalization is an accurate strategy for predicting clinical deterioration of patients with COVID-19.

Keywords: COVID-19; lung ultrasound; pneumonia; point-of-care ultrasound; prognosis.

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Conflict of interest statement

The authors declare no conflict of interest.

Figures

Figure 1
Figure 1
Lung ultrasound examination protocol using 10 zones.
Figure 2
Figure 2
Consort 2010 flow chart of patients with COVID-19 admitted to Spanish hospitals and included in the PREDECHOVID study. LUS: lung ultrasound; ICU: intersive care unit.
Figure 3
Figure 3
Distribution of LUS findings at admission and 72 h later.
Figure 4
Figure 4
Discrimination power by means of the receiver operator characteristic and its area under the curve (AUC-ROC) of SCORE-1, SCORE-2 and DIFFERENTIAL SCORE.
Figure 5
Figure 5
Suggested algorithm using serial LUS.
See this image and copyright information in PMC

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