Prognostic Performance of Bedside Lung Ultrasound Score (LUSS) and ROX Index in Hypoxemic Respiratory Failure Due to COVID-19
Abstract
:1. Introduction
2. Materials and Methods
- Age ≥ 18 years;
- Confirmed COVID-19 pneumonia (positive test result using reverse-transcriptase polymerase chain reaction, RT-PCR, assay of a nasopharyngeal swab); Alert of the hospital Medical Emergency Team for clinical worsening: PaO2/FiO2 ratio < 300 mmHg despite oxygen therapy, respiratory rate > 22 breaths per minute and/or respiratory distress.
2.1. LUS Protocol
- Lung parenchyma score: A score of 0 was assigned for no B-lines in a single intercostal space, a score of 1 was assigned for multiple spaced or isolated B-lines, a score of 2 was assigned for diffuse coalescent B-lines, and a score of 3 was assigned for lung consolidations.
- Pleural line score: A score of 0 was assigned for a normal, continuous, hyperechoic pleural line; a score of 1 was assigned for a discontinuous, irregular pleural line; and a score of 2 was assigned for a broken or a blurred pleural line.
2.2. Clinical Data
2.3. Statistical Analyses
3. Results
3.1. Study Population
3.2. Ventilatory Variables and Outcomes
3.3. Multivariable Analyses
3.4. Prognostic Performance of the 3 Indices
3.5. Unadjusted Survival Analysis at 30-Day Follow-Up
4. Discussion
- −
- All three indices (ROX, LUSS and LUSS/ROX) were independently associated with a negative outcome in the univariable analysis, and this association was confirmed in the multivariable analyses.
- −
- Although the comparison between the AUC of LUSS or ROX versus LUSS/ROX did not reveal a statistically significant difference, we observed a trend toward a better outcome prediction using the LUSS/ROX index as compared to using LUSS; furthermore, the AUROC of the combined LUSS/ROX index improved the low sensitivity of LUSS and the low specificity of the ROX index.
- −
- Using the Kaplan–Meier approach, a statistically significant difference in survival without invasive mechanical ventilation was observed by stratifying the population using all three indices. We observed a higher probability of survival without mechanical ventilation over the 30-day follow-up by using the combined LUSS/ROX best cut-off (p = 0.0000 by log-rank test) (Figure 2c) when compared with LUSS best cut-off (p = 0.0015 by log-rank test) (Figure 2a).
5. Conclusions
Author Contributions
Funding
Institutional Review Board Statement
Informed Consent Statement
Data Availability Statement
Conflicts of Interest
References
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Overall Population n = 79 | Negative Outcome n = 24 (30%) | Positive Outcome n = 55 (70%) | p-Value | |
---|---|---|---|---|
Demographics | ||||
Age, years | 61 [52–71] | 68 [59–75] | 60 [50–70] | 0.067 |
Sex, female, n | 28 (35%) | 9 (38%) | 19 (35%) | 0.801 |
BMI, Kg/m2 | 28 [26–33] | 30 [27–34] | 27 [25–32] | 0.052 |
Comorbidities | ||||
COPD | 11 (14%) | 3 (13%) | 8 (15%) | 0.809 |
Diabetes | 7 (9%) | 1 (4%) | 6 (11%) | 0.332 |
Chronic renal failure | 1 (1%) | 0 (0%) | 1 (2%) | 0.506 |
Hypertension | 31 (39%) | 11 (46%) | 20 (36%) | 0.428 |
Ischemic cardiomyopathy | 3 (4%) | 2 (8%) | 1 (2%) | 0.164 |
Neoplasia | 2 (2%) | 1 (4%) | 1 (2%) | 0.541 |
Immunosuppression | 2 (2%) | 2 (8%) | 0 (0%) | 0.030 |
Ventilatory setting | ||||
Venturi mask | 10 (13%) | 1 (4%) | 9 (16%) | 0.143 |
HFNO | 3 (4%) | 0 (0%) | 3 (5%) | |
CPAP | 66 (84%) | 23 (96%) | 43 (78%) | |
PEEP, cmH2O | 8 [5–10] | 10 [8–10] | 8 [5–10] | 0.014 |
FiO2 | 60 [50–80] | 75 [65–100] | 50 [50–70] | <0.001 |
Clinical illness severity | ||||
SOFA baseline | 2 [2–2] | 2 [2–2] | 2 [1–2] | 0.299 |
PCR (mg/L) | 6.70 [3.40–12.27] | 5.00 [3.37–12.90] | 7.36 [3.87–11.78] | 0.534 |
Lymphocytes (cells/mL) | 853 (±316) | 760 (±72) | 889 (±41) | 0.112 |
D-dimer (μg/mL) | 345 [208–540] | 386 [260–536] | 334 [208–540] | 0.431 |
PaO2, mmHg | 131 [89–210] | 118 [87–220] | 134 [92–210] | 0.561 |
PaCO2, mmHg | 36 [33–40] | 37 [33–41] | 36 [33–40] | 0.685 |
SpO2, % | 99 [97–99] | 98 [97–99] | 99 [98–99] | 0.326 |
PaO2/FiO2 | 245 (±101) | 197 (±93) | 266 (±98) | 0.005 |
RR, breaths per minute | 24 [20–28] | 26 [22–31] | 24 [20–26] | 0.028 |
NIV failure indices | ||||
ROX index | 7.07 [5.51–9.80] | 5.14 [3.43–7.01] | 7.55 [6.25–10.00] | <0.001 |
LUSS | 27 (±9) | 31 (±8) | 25 (±9) | <0.001 |
LUSS/ROX | 3.70 [2.49–5.73] | 6.02 [3.94–8.76] | 3.43 [2.10–4.29] | <0.001 |
Variable | OR (95% CI) | p-Value | OR (95% CI) | p-Value | OR (95% CI) | p-Value |
---|---|---|---|---|---|---|
BMI | 1.077 (0.94–1.23) | 0.277 | 1.07 (0.95–1.22) | 0.260 | 1.08 (0.94–1.23) | 0.280 |
Age | 1.013 (0.96–1.06) | 0.604 | 1.01 (0.97–1.06) | 0.248 | 1.01 (0.97–1.06) | 0.591 |
PEEP | 1.289 (1.03–1.62) | 0.029 | 1.22 (0.97–1.53) | 0.093 | 1.23 (0.98–1.54) | 0.073 |
PaO2/FiO2 | 0.992 (0.99–1.00) | 0.020 | 0.99 (0.99–1.00) | 0.069 | 0.99 (0.99–1.00) | 0.064 |
RR | 0.974 (0.83–1.14) | 0.749 | 1.13 (1.00–1.27) | 0.047 | 1.02 (0.89–1.17) | 0.775 |
ROX | 0.706 (0.51–0.98) | 0.039 | ||||
LUSS | 1.08 (1.00–1.17) | 0.045 | ||||
LUSS/ROX | 1.35 (1.04–1.76) | 0.023 | ||||
AIC | 84 | 85 | 84 |
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Nova, A.; Rezoagli, E.; Eronia, N.; Benini, A.; Scognamiglio, A.; Foti, G.; Bellani, G. Prognostic Performance of Bedside Lung Ultrasound Score (LUSS) and ROX Index in Hypoxemic Respiratory Failure Due to COVID-19. Diagnostics 2023, 13, 1361. https://doi.org/10.3390/diagnostics13071361
Nova A, Rezoagli E, Eronia N, Benini A, Scognamiglio A, Foti G, Bellani G. Prognostic Performance of Bedside Lung Ultrasound Score (LUSS) and ROX Index in Hypoxemic Respiratory Failure Due to COVID-19. Diagnostics. 2023; 13(7):1361. https://doi.org/10.3390/diagnostics13071361
Chicago/Turabian StyleNova, Alice, Emanuele Rezoagli, Nilde Eronia, Annalisa Benini, Andrea Scognamiglio, Giuseppe Foti, and Giacomo Bellani. 2023. "Prognostic Performance of Bedside Lung Ultrasound Score (LUSS) and ROX Index in Hypoxemic Respiratory Failure Due to COVID-19" Diagnostics 13, no. 7: 1361. https://doi.org/10.3390/diagnostics13071361