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Lung ultrasound for the early diagnosis of COVID-19 pneumonia: an international multicenter study.

肺部超声早期诊断新型冠状病毒肺炎例肺炎: 一项国际多中心研究.

  • 影响因子:4.19
  • DOI:10.1007/s00134-021-06373-7
  • 作者列表:"Volpicelli G","Gargani L","Perlini S","Spinelli S","Barbieri G","Lanotte A","Casasola GG","Nogué-Bou R","Lamorte A","Agricola E","Villén T","Deol PS","Nazerian P","Corradi F","Stefanone V","Fraga DN","Navalesi P","Ferre R","Boero E","Martinelli G","Cristoni L","Perani C","Vetrugno L","McDermott C","Miralles-Aguiar F","Secco G","Zattera C","Salinaro F","Grignaschi A","Boccatonda A","Giostra F","Infante MN","Covella M","Ingallina G","Burkert J","Frumento P","Forfori F","Ghiadoni L","on behalf of the International Multicenter Study Group on LUS in COVID-19.
  • 发表时间:2021-04-01
Abstract

PURPOSE:To analyze the application of a lung ultrasound (LUS)-based diagnostic approach to patients suspected of COVID-19, combining the LUS likelihood of COVID-19 pneumonia with patient's symptoms and clinical history. METHODS:This is an international multicenter observational study in 20 US and European hospitals. Patients suspected of COVID-19 were tested with reverse transcription-polymerase chain reaction (RT-PCR) swab test and had an LUS examination. We identified three clinical phenotypes based on pre-existing chronic diseases (mixed phenotype), and on the presence (severe phenotype) or absence (mild phenotype) of signs and/or symptoms of respiratory failure at presentation. We defined the LUS likelihood of COVID-19 pneumonia according to four different patterns: high (HighLUS), intermediate (IntLUS), alternative (AltLUS), and low (LowLUS) probability. The combination of patterns and phenotypes with RT-PCR results was described and analyzed. RESULTS:We studied 1462 patients, classified in mild (n = 400), severe (n = 727), and mixed (n = 335) phenotypes. HighLUS and IntLUS showed an overall sensitivity of 90.2% (95% CI 88.23-91.97%) in identifying patients with positive RT-PCR, with higher values in the mixed (94.7%) and severe phenotype (97.1%), and even higher in those patients with objective respiratory failure (99.3%). The HighLUS showed a specificity of 88.8% (CI 85.55-91.65%) that was higher in the mild phenotype (94.4%; CI 90.0-97.0%). At multivariate analysis, the HighLUS was a strong independent predictor of RT-PCR positivity (odds ratio 4.2, confidence interval 2.6-6.7, p < 0.0001). CONCLUSION:Combining LUS patterns of probability with clinical phenotypes at presentation can rapidly identify those patients with or without COVID-19 pneumonia at bedside. This approach could support and expedite patients' management during a pandemic surge.

摘要

目的: 结合新型冠状病毒肺炎例肺炎患者的症状和临床病史,分析肺部超声 (LUS) 诊断方法在新型冠状病毒肺炎例疑似肺炎患者中的应用。 方法: 这是一项在20家美国和欧洲医院进行的国际多中心观察性研究。对疑似新型冠状病毒肺炎的患者进行逆转录-聚合酶链反应 (rt-pcr) 拭子检测,并进行LUS检查。我们基于预先存在的慢性疾病 (混合表型) 以及就诊时呼吸衰竭的体征和/或症状的存在 (严重表型) 或不存在 (轻度表型),确定了三种临床表型。我们根据四种不同的模式定义了新型冠状病毒肺炎肺炎的LUS可能性: 高 (HighLUS) 、中 (IntLUS) 、备选 (AltLUS) 和低 (LowLUS) 概率。描述和分析了模式和表型与rt-pcr结果的组合。 结果: 我们研究了1462例患者,分为轻度 (n = 400) 、重度 (n = 727) 和混合 (n = 335) 表型。HighLUS和IntLUS在识别rt-pcr阳性患者方面显示出90.2% 的总体灵敏度 (95% CI 88.23-91.97%),在混合 (94.7%) 和严重表型 (97.1%) 中具有更高的值,在那些有客观呼吸衰竭的患者中甚至更高 (99.3%)。HighLUS显示88.8% 的特异性 (CI 85.55-91.65%),在轻度表型中更高 (94.4%; CI 90.0-97.0%)。在多变量分析中,HighLUS是rt-pcr阳性的强独立预测因子 (比值比4.2,置信区间2.6-6.7,p <0.0001)。 结论: 将LUS概率模式与临床表型相结合,可以快速识别床边有或没有新型冠状病毒肺炎肺炎的患者。这种方法可以在大流行期间支持和加快患者的管理。

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影响因子:2.68
发表时间:2021-02-01
DOI:10.1080/14656566.2020.1814255
作者列表:["Sawada H","Oeda T","Kohsaka M","Tomita S","Umemura A","Park K","Yamamoto K","Kiyohara K"]

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发表时间:2021-03-24
DOI:10.1007/s11033-021-06299-9
作者列表:["Louvrier A","Terranova L","Meyer C","Meyer F","Euvrard E","Kroemer M","Rolin G"]

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