The lung ultrasound "Rule of 7" in the prognosis of COVID-19 patients: Results from a prospective multicentric study.

Purpose: There is growing evidence regarding the imaging findings of coronavirus disease 2019 (COVID-19) in lung ultrasound (LUS), however the use of a combined prognostic and triage tool has yet to be explored.To determine the impact of the LUS in the prediction of the mortality of patients with highly suspected or confirmed COVID-19.The secondary outcome was to calculate a score with LUS findings with other variables to predict hospital admission and emergency department (ED) discharge. Material and methods: Prospective study performed in the ED of three academic hospitals. Patients with highly suspected or confirmed COVID-19 underwent a LUS examination and laboratory tests. Results: A total of 228 patients were enrolled between March and September 2020. The mean age was 61.9 years (Standard Deviation - SD 21.1). The most common findings in LUS was a right posteroinferior isolated irregular pleural line (53.9%, 123 patients). A logistic regression model was calculated, including age over 70 years, C-reactive protein (CRP) over 70 mg/L and a lung score over 7 to predict mortality, hospital admission and discharge from the ED. We obtained a predictive model with a sensitivity of 56.8% and a specificity of 87.6%, with an AUC of 0.813 [p < 0.001]. Conclusions: The combination of LUS, clinical and laboratory findings in this easy to apply "rule of 7" showed excellent performance to predict hospital admission and mortality.

Objetivo: Existe una evidencia creciente con respecto a los hallazgos de imagen de la enfermedad por coronavirus 2019 (COVID-19) en la ecografía pulmonar (LUS), sin embargo, aún no se ha explorado el uso de una herramienta combinada de pronóstico y triaje.El objetivo principal de este estudio fue determinar el impacto de la LUS en la predicción de la mortalidad de los pacientes con sospecha de afectación pulmonar por COVID-19. El objetivo secundario fue calcular una puntuación con los hallazgos del LUS con otras variables para predecir el ingreso hospitalario y el alta del servicio de urgencias (SU). Material y métodos: Estudio prospectivo realizado en urgencias de tres hospitales académicos, en pacientes con sospecha de COVID-19 o confirmación de esta, a los que se sometió a un examen de LUS y pruebas de laboratorio. Resultados: Se inscribieron un total de 228 pacientes entre marzo y septiembre de 2020. La edad media fue de 61,9 años (DE 21,1). El hallazgo más común en la LUS fue la irregularidad pleural posteroinferior derecha (53,9%, 123 pacientes). Se calculó un modelo de regresión logística, que incluyó la edad mayor de 70 años, proteína C reactiva (PCR) mayor de 70 mg/L y puntuación de afectación pulmonar mediante LUS score superior a 7 para predecir la mortalidad, el ingreso hospitalario y el alta del SU. Se obtuvo una sensibilidad del 56,8% y una especificidad del 87,6%, con un AUC de 0,813 [p < 0,001] para dicho modelo predictivo, en materia de mortalidad. Conclusiones: La combinación de LUS, hallazgos clínicos y de laboratorio en esta «regla de 7¼ de fácil aplicación se mostró de utilidad para predecir el ingreso hospitalario y la mortalidad.

Point-of-care ultrasonography in the initial characterization of patients with COVID-19.

BACKGROUND: There is growing evidence regarding the imaging findings of coronavirus disease 2019 (COVID-19) in chest X-rays and computed tomography scans; however, their availability during this pandemic outbreak might be compromised. Currently, the role of point-of-care ultrasonography (POCUS) has yet to be explored. OBJECTIVES: To describe the POCUS findings of COVID-19 in patients with the disease admitted to the emergency department (ED), correlating them with vital signs, laboratory and radiologic results, therapeutic decisions, and the prognosis. METHODS: Prospective study performed in the ED of 2 academic hospitals. Patients with highly suspected or confirmed COVID-19 underwent a lung ultrasonography (lung POCUS), focused cardiac ultrasound (FOCUS), and inferior vena cava (IVC) exam. RESULTS: Between March and April 2020, 96 patients were enrolled. The mean age was 68.2 years (SD 17.5). The most common findings in the lung POCUS were an irregular pleural line (63.2%), bilateral confluence (55.2%), and isolated B-lines (53.1%), which were associated with a positive RT-PCR (odds ratio 4.327; 95% CI 1.216-15.401; p < .001), and correlated with IL-6 levels (rho = 0.622; p = .002). The IVC negatively correlated with levels of expiratory pO2 (rho = -0.539; p = .014) and inspiratory pO2 (rho = -0.527; p = 0.017), and expiratory diameter positively correlated with troponin I (rho = 0.509; p = .03). After the POCUS exam, almost 20% of the patients had an associated condition that required a change in their treatment or management. CONCLUSIONS: POCUS parameters have the potential to impact the diagnosis, management, and prognosis of patients with confirmed or suspected COVID-19.

ANTECEDENTES: Existe una evidencia creciente con respecto a los hallazgos por imagen de la COVID-19, tanto en radiografías de tórax como en tomografía computarizada; sin embargo, la disponibilidad de estas técnicas durante la pandemia podría verse comprometida. OBJETIVOS: Describir los hallazgos en la ecografía en el punto de atención (POCUS) en pacientes con COVID-19 que consultaron en el servicio de urgencias (SU), correlacionándolos con signos vitales, resultados analíticos y radiológicos, decisiones terapéuticas y pronóstico. MÉTODOS: Estudio prospectivo realizado en los SU de dos hospitales académicos. Los pacientes con COVID-19 con alta sospecha o confirmada se sometieron a una ecografía pulmonar (POCUS pulmonar), una ecocardioscopia y una ecografía de la vena cava inferior (VCI). RESULTADOS: Entre marzo y abril del 2020, se reclutaron 96 pacientes. La edad media fue de 68,2 años (DE 17,5). Los hallazgos más comunes en el POCUS pulmonar fueron la línea pleural irregular (63,2%), las líneas B confluyentes bilateral (55,2%) y aisladas (53,1%), que se vincularon con una RT-PCR (odds ratio 4,327; IC 95% 1,216 a 15,401; p < 0,001), y se asoció con los niveles de interleucina-6 (IL-6) (ρ = 0,622; p = 0,002). La VCI se correlacionó negativamente con los niveles de pO2 espiratorio (ρ = − 0,539; p = 0,014) y pO2 inspiratorio (ρ = − 0,527; p = 0,017), y el diámetro espiratorio se relacionó positivamente con la troponina I (ρ = 0,509; p = 0, 03). Después del examen POCUS, casi el 20% de los pacientes tenían una condición asociada que requería un cambio en el tratamiento o manejo previo. CONCLUSIONES: Los parámetros POCUS tienen el potencial de afectar el diagnóstico, manejo y pronóstico de pacientes con sospecha o confirmación de COVID-19.

The lung ultrasound "Rule of 7" in the prognosis of COVID-19 patients: Results from a prospective multicentric study.

PURPOSE: There is growing evidence regarding the imaging findings of coronavirus disease 2019 (COVID-19) in lung ultrasound (LUS), however the use of a combined prognostic and triage tool has yet to be explored. To determine the impact of the LUS in the prediction of the mortality of patients with highly suspected or confirmed COVID-19.The secondary outcome was to calculate a score with LUS findings with other variables to predict hospital admission and emergency department (ED) discharge. MATERIAL AND METHODS: Prospective study performed in the ED of three academic hospitals. Patients with highly suspected or confirmed COVID-19 underwent a LUS examination and laboratory tests. RESULTS: A total of 228 patients were enrolled between March and September 2020. The mean age was 61.9 years (Standard Deviation - SD 21.1). The most common findings in LUS was a right posteroinferior isolated irregular pleural line (53.9%, 123 patients). A logistic regression model was calculated, including age over 70 years, C-reactive protein (CRP) over 70mg/L and a lung score over 7 to predict mortality, hospital admission and discharge from the ED. We obtained a predictive model with a sensitivity of 56.8% and a specificity of 87.6%, with an AUC of 0.813 [p<0.001]. CONCLUSIONS: The combination of LUS, clinical and laboratory findings in this easy to apply "rule of 7" showed excellent performance to predict hospital admission and mortality.

COVID-19 multisystemic inflammatory syndrome in adults: a not to be missed diagnosis.

We report COVID-19 multisystemic inflammatory syndrome in an adult patient with an atypical presentation (mild abdominal pain) and a negative (repeated) reverse transcriptase-PCR, in the absence of lung involvement on lung ultrasound. In this case, focused cardiac ultrasound revealed signs of myopericarditis and enabled us to focus on the problem that was putting our patient in a perilous situation, with a quick, non-time-consuming and easy-to-access technique. Serology test was performed and SARS-CoV-2 infection was confirmed more than a week after admission to the coronary unit. As the patient had a general good appearance, the potential implications of missing this diagnosis could have been fatal.

[Point-of-care ultrasonography in the initial characterization of patients with COVID-19]. / La ecografía clínica en la caracterización inicial de los pacientes con COVID-19.

BACKGROUND: There is growing evidence regarding the imaging findings of coronavirus disease 2019 (COVID-19) in chest X-rays and computed tomography scans; however, their availability during this pandemic outbreak might be compromised. Currently, the role of point-of-care ultrasonography (POCUS) has yet to be explored. OBJECTIVES: To describe the POCUS findings of COVID-19 in patients with the disease admitted to the emergency department (ED), correlating them with vital signs, laboratory and radiologic results, therapeutic decisions, and the prognosis. METHODS: Prospective study performed in the ED of 2 academic hospitals. Patients with highly suspected or confirmed COVID-19 underwent a lung ultrasonography (lung POCUS), focused cardiac ultrasound (FOCUS), and inferior vena cava (IVC) exam. RESULTS: Between March and April 2020, 96 patients were enrolled. The mean age was 68.2 years (SD 17.5). The most common findings in the lung POCUS were an irregular pleural line (63.2%), bilateral confluence (55.2%), and isolated B-lines (53.1%), which were associated with a positive RT-PCR (odds ratio 4.327; 95% CI 1.216-15.401; p<.001), and correlated with IL-6 levels (rho=0.622; p=.002). The IVC negatively correlated with levels of expiratory pO2 (rho=-0.539; p=.014) and inspiratory pO2 (rho=-0.527; p=0.017), and expiratory diameter positively correlated with troponin I (rho=0.509; p=.03). After the POCUS exam, almost 20% of the patients had an associated condition that required a change in their treatment or management. CONCLUSIONS: POCUS parameters have the potential to impact the diagnosis, management, and prognosis of patients with confirmed or suspected COVID-19.