ABSTRACT
The major causes of death of patients with COVID-19 include metabolic acidosis, septic shock, pulmonary edema, multiple organ failure and deep venous thrombosis. These systemic manifestations are associated with severe pathological damages of vital organs like lung and kidney that are caused by inflammatory storms. The occurrence, development and deterioration of disease is closely associated with the immune imbalance mechanisms such as disorder of lymphocyte subsets and emergence of cytokine storm. The cellular immunity plays a vital role. The expression levels of some blood inflammatory factors of the severe COVID-19 patients are remarkably elevated, IL-6 is a typical proinflammatory factor that causes the cytokine storm, which can be used for prediction of prognosis. IL-6 blockade may be an effective method to block the cytokine storm.
ABSTRACT
Background: Bedside lung ultrasound (LUS) has emerged as a useful and noninvasive tool to detect lung involvement and monitor changes in patients with coronavirus disease 2019 (COVID-19). However, the clinical significance of the LUS score in patients with COVID-19 remains unknown. We aimed to investigate the prognostic value of the LUS score in patients with COVID-19. Methods: : The LUS protocol consisted of 12 scanning zones and was performed in 280 consecutive patients with COVID-19. The LUS score based on B-lines, lung consolidation and pleural line abnormalities was evaluated. Results: : The median time from admission to LUS examinations was 7 days (interquartile range [IQR] 3-10). Patients in the highest LUS score group were more likely to have a lower lymphocyte percentage (LYM%); higher levels of D-dimer, C-reactive protein, hypersensitive troponin I and creatine kinase muscle-brain; more invasive mechanical ventilation therapy; higher incidence of ARDS; and higher mortality than patients in the lowest LUS score group. After a median follow-up of 14 days [IQR, 10-20 days], 37 patients developed ARDS, and 13 died. Patients with adverse outcomes presented a higher rate of bilateral involvement; more involved zones and B-lines, pleural line abnormalities and consolidation; and a higher LUS score than event-free survivors. The Cox models adding the LUS score as a continuous variable (hazard ratio [HR]: 1.05, 95% confidence intervals [CI]: 1.02～1.08; P < 0.001; Akaike Information Criterion [AIC] =272; C-index = 0.903) or as a categorical variable (HR: 10.76, 95% CI: 2.75～42.05; P = 0.001; AIC =272; C-index = 0.902) were found to predict poor outcomes more accurately than the basic model (AIC =286; C-index = 0.866). An LUS score cut-off >12 predicted adverse outcomes with a specificity and sensitivity of 90.5% and 91.9%, respectively. Conclusions: : The LUS score devised by our group performs well at predicting adverse outcomes in patients with COVID-19 and is important for risk stratification in COVID-19 patients.
Subject(s)
COVID-19 , Pleural DiseasesABSTRACT
Background: Bedside lung ultrasound (LUS) has emerged as a useful and non-invasive tool to detect lung involvement and monitor changes in patients with coronavirus disease 2019(COVID-19). While the clinical significance of LUS-score in patients with COVID-19 remains unknown. We aimed to investigate the prognostic value of LUS-score in patients with COVID-19.MethodsLUS protocol consisted of 12 scanning zones and was performed in 280 consecutive patients with COVID-19. LUS-score based on B-lines, pleural line abnormalities and lung consolidation was evaluated. The primary outcome was a combination of severe acute respiratory distress syndrome (ARDS), and mortality.ResultsCompared with patients in the lowest LUS-score group, those in the highest LUS-score group were more likely to have a lower lymphocyte%, higher levels of D-dimer, C-reactive protein, hypersensitive troponin I and creatine kinase muscle-brain, more invasive mechanical ventilation therapy, higher incidence of ARDS, and higher mortality. After a median follow-up of 14 days, 37 patients progressed to the poor outcome. Compared with event-free survivors, patients with adverse event presented higher rate of bilateral involved, more involved zones and B-lines, pleural lines abnormalities and consolidation, and higher LUS-score. The Cox models adding LUS-score as a continuous variable (hazard ratio [HR]: 1.05, 95% confidence intervals [CI]: 1.02~1.08; P < 0.001; Akaike Information Criterion [AIC] =272; C-index = 0.903) or as a categorical variable (HR: 10.76, 95% CI: 2.75~42.05; P = 0.001; AIC =272; C-index = 0.902) were found to predict poor outcome more accurately than the basic model (AIC =286; C-index = 0.866). LUS-score cutoff >12 would predict adverse events with specificity and sensitivity of 90.5% and 91.9%, respectively.ConclusionsLUS-score is a powerful predictor of adverse events in patients with COVID-19, and is important for risk stratification in COVID-19 patients.