Evaluación precoz mediante ecografía pulmonar de pacientes con disnea por COVID-19 / Early assessment of patients with COVID-19 and dyspnea using lung ultrasound scoring

Objetivos: El objetivo principal fue evaluar la precisión de la escala de ecografía pulmonar modificada (MLUS) para predecir la necesidad de soporte respiratorio en las primeras 48 horas en pacientes con disnea por COVID-19. Los objetivos secundarios fueron comparar la escala MLUS con la escala National Early Warning Score 2 (NEW2) y la combinación de ambas para predecir la gravedad según la escala de la OMS y comparar las escalas de gravedad calculadas por ecografía y tomografía computarizada (TC) pulmonar. Método: Estudio observacional de cohortes prospectivo multicéntrico realizado desde 30 de marzo al 30 de abril de 2020 en 2 hospitales universitarios. Se incluyeron pacientes adultos con disnea por COVID-19. Se les realizó una ecografía pulmonar inicial y se calculó la escala MLUS, escala NEW2 y la escala de gravedad calculada por TC pulmonar. Los pacientes se clasificaron como de riesgo bajo (BR) si < 5 puntos o de riesgo alto (AR) si $ 5 puntos según la escala de la OMS a las 48 horas. Resultados: Se incluyeron 100 pacientes, 35 (35%) fueron de BR y 65 (65%) de AR. La correlación entre la escala MLUS y las puntuaciones de la escala ordinal de la OMS fue positiva y muy alta (rho de Spearman = 0,832; p < 0,001). El área bajo la curva COR de la escala MLUS, NEW2 y combinada fue de 0,96 (0,93-0,99), 0,89 (0,82-0,95) y 0,98 (0,96-1,0), respectivamente, para predecir el grupo de RA. Hubo relación entre las escalas MLUS y lesiones pulmonares en la TC. Conclusión: Una ecografía pulmonar inicial puede predecir la gravedad clínica de los pacientes con disnea por COVID-19. (AU)

Objectives: The main objective was to evaluate the precision of the Modified Lung Ultrasound (MLUS score) for predicting the need for respiratory support in the first 48 hours in patients with dyspnea due to the coronavirus disease 2019 (COVID-19). The secondary objectives were 1) to compare the MLUS and National Early Warning Score 2 (NEWS2), as well as the combination of both scores, as predictors of severity according to the World Health Organization (WHO) Ordinal Scale for Clinical Improvement; and 2) to compare severity assessed by ultrasound scoring to severity assessed by lung computed tomography (CT). Material and methods: Multicenter prospective observational cohort study conducted from March 30 to April 30, 2020, in 2 university hospitals. Adult patients with dyspnea due to COVID-19 were included. An initial lung ultrasound was performed, and the results of MLUS, NEW2, and lung CT evaluations were recorded. Patients were classified by risk according to the WHO scale at 48 hours, as follows: low risk (score less than 5) or high risk (score of 5 or more). Results: A total of 100 patients were included: 35 (35%) were classified as low risk and 65 (65%) as high risk. The correlation between the MLUS and WHO assessments was positive and very high (Spearman rank correlation 􀁕 = 0.832; P .001). The area under the receiver operating characteristic curves of the MLUS, NEW2 and combined ultrasound scores, in relation to prediction of risk classification were, respectively, 0.96 (0.93-0.99), 0.89 (0.82-0.95) and 0.98 (0.96-1.0). The MLUS and lung CT assessments were correlated. Conclusion: An early lung ultrasound score can predict clinical severity in patients with dyspnea due to COVID-19.

Early assessment of patients with COVID-19 and dyspnea using lung ultrasound scoring. / Evaluación precoz mediante ecografía pulmonar de pacientes con disnea por COVID-19.

OBJECTIVES: The main objective was to evaluate the precision of the Modified Lung Ultrasound (MLUS score) for predicting the need for respiratory support in the first 48 hours in patients with dyspnea due to the coronavirus disease 2019 (COVID-19). The secondary objectives were 1) to compare the MLUS and National Early Warning Score 2 (NEWS2), as well as the combination of both scores, as predictors of severity according to the World Health Organization (WHO) Ordinal Scale for Clinical Improvement; and 2) to compare severity assessed by ultrasound scoring to severity assessed by lung computed tomography (CT). MATERIAL AND METHODS: Multicenter prospective observational cohort study conducted from March 30 to April 30, 2020, in 2 university hospitals. Adult patients with dyspnea due to COVID-19 were included. An initial lung ultrasound was performed, and the results of MLUS, NEW2, and lung CT evaluations were recorded. Patients were classified by risk according to the WHO scale at 48 hours, as follows: low risk (score less than 5) or high risk (score of 5 or more). RESULTS: A total of 100 patients were included: 35 (35%) were classified as low risk and 65 (65%) as high risk. The correlation between the MLUS and WHO assessments was positive and very high (Spearman rank correlation 􀁕 = 0.832; P .001). The area under the receiver operating characteristic curves of the MLUS, NEW2 and combined ultrasound scores, in relation to prediction of risk classification were, respectively, 0.96 (0.93-0.99), 0.89 (0.82-0.95) and 0.98 (0.96-1.0). The MLUS and lung CT assessments were correlated. CONCLUSION: An early lung ultrasound score can predict clinical severity in patients with dyspnea due to COVID-19.

OBJETIVO: El objetivo principal fue evaluar la precisión de la escala de ecografía pulmonar modificada (MLUS) para predecir la necesidad de soporte respiratorio en las primeras 48 horas en pacientes con disnea por COVID-19. Los objetivos secundarios fueron comparar la escala MLUS con la escala National Early Warning Score 2 (NEW2) y la combinación de ambas para predecir la gravedad según la escala de la OMS y comparar las escalas de gravedad calculadas por ecografía y tomografía computarizada (TC) pulmonar. METODO: Estudio observacional de cohortes prospectivo multicéntrico realizado desde 30 de marzo al 30 de abril de 2020 en 2 hospitales universitarios. Se incluyeron pacientes adultos con disnea por COVID-19. Se les realizó una ecografía pulmonar inicial y se calculó la escala MLUS, escala NEW2 y la escala de gravedad calculada por TC pulmonar. Los pacientes se clasificaron como de riesgo bajo (BR) si 5 puntos o de riesgo alto (AR) si 5 puntos según la escala de la OMS a las 48 horas. RESULTADOS: Se incluyeron 100 pacientes, 35 (35%) fueron de BR y 65 (65%) de AR. La correlación entre la escala MLUS y las puntuaciones de la escala ordinal de la OMS fue positiva y muy alta (rho de Spearman = 0,832; p 0,001). El área bajo la curva COR de la escala MLUS, NEW2 y combinada fue de 0,96 (0,93-0,99), 0,89 (0,82-0,95) y 0,98 (0,96-1,0), respectivamente, para predecir el grupo de RA. Hubo relación entre las escalas MLUS y lesiones pulmonares en la TC. CONCLUSIONES: Una ecografía pulmonar inicial puede predecir la gravedad clínica de los pacientes con disnea por COVID-19.

Clinical research assessment by flow cytometry of biomarkers for infectious stratification in an Emergency Department.

Aim: Management of patients with infections within the Emergency Department (ED) is challenging for practitioners, as the identification of infectious causes remains difficult with current techniques. A new combination of two biomarkers was tested with a new rapid flow cytometry technique. Materials & methods: Subjects from the ED were tested for their CD64 on neutrophils (nCD64) and CD169 on monocytes (mCD169) levels and results were compared to their clinical records. Results: Among 139 patients, 29% had confirmed bacterial infections and 5% viral infections. nCD64 and mCD169 respectively showed 88 and 86% sensitivity and 90 and 100% specificity for identifying subjects in bacterial or viral conditions. Conclusion: This point-of-care technique could allow better management of patients in the ED.