The following is a summary of “Application and internal validation of lung ultrasound score in COVID-19 setting: The ECOVITA observational study,” published in the May 2024 issue of Pulmonology by Rinaldi et al.

Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) continues to cause significant morbidity and mortality, primarily through the development of respiratory failure. This study aimed to validate the lung ultrasound score as a predictor of mortality and the clinical severity related to the need for respiratory support.

In this prospective, multicenter, hospital-based cohort study, researchers included all adult patients diagnosed with SARS-CoV-2 infection confirmed by real-time reverse transcription polymerase chain reaction (RT-PCR). Upon admission, all patients underwent blood gas analysis and lung ultrasound performed by expert operators. The ultrasound scan acquisition targeted 12 specific anatomical landmarks of the chest. Lung ultrasound findings were classified according to a scoring system ranging from 0 to 3: Score 0 indicated normal A-lines; Score 1 indicated multiple separated B-lines; Score 2 indicated coalescent B-lines with pleural line alterations; Score 3 indicated areas of consolidation.

A total of 1,007 patients were included in the statistical analysis (62.4% male, mean age 66.3 years). Oxygen support was required in 811 patients (80.5%). The median ultrasound score was 24, and higher scores were associated with an increased risk of requiring more invasive respiratory support. The lung ultrasound score showed a strong negative correlation (rho: -0.71) with the P/F ratio and was significantly associated with in-hospital mortality (OR 1.11, 95% CI 1.07–1.14; p < 0.001), even after adjusting for variables such as age, sex, P/F ratio, SpO2, lactate, hypertension, chronic renal failure, diabetes, and obesity.

This study validates the 12-field lung ultrasound score as a robust tool for predicting mortality and the severity of clinical outcomes in patients with COVID-19. Baseline lung ultrasound scores were strongly associated with in-hospital mortality and the need for intensive respiratory support, demonstrating their predictive value for the risk of invasive oxygen therapy among patients with COVID-19. These findings support the integration of lung ultrasound scores into clinical practice for better management and prognosis of COVID-19-related respiratory failure.

Source: sciencedirect.com/science/article/pii/S2531043724000564