Figures
- FIGURE 1
Median focused lung ultrasound (FLUS) scores for the different end-points. Statistically significant higher FLUS score was found in patients who received mechanical ventilation (p<0.001), were admitted to intensive care (p<0.001), were treated with high-flow oxygen (p<0.001), who died of COVID-19 (p=0.004) and who died of any cause (p=0.01).
- FIGURE 2
Correlation and Bland–Altman plot of median focused lung ultrasound (FLUS) scores in randomly selected patients by two blinded observers. Little and clinically insignificant difference in scores is seen even though there is a trend (α: 0.36, p=0.01) with increasing difference as median FLUS score increases.
- FIGURE 3
Receiver operating characteristics of different scorings systems. The median focused lung ultrasound (FLUS) score and total sum from all zones and the median FLUS score from the anterior and lateral zones had higher area under the curve than other scoring systems.
Tables
- TABLE 1
Demographic, vital parameters, blood test results and end-points in the study population
Variable Observations, N Mean±sd, n (%) or % Study information Patients included in study 415 Patients excluded due to no lung ultrasound film clips available analysis 17 Patients analysed 398 96 Site 1 201 50.5 Site 2 82 20.6 Site 3 69 17.3 Site 4 46 11.6 Demographics Age years 387 67.8±15.8 Weight kg 242 78.4±19.7 Height cm 246 171.6±10.1 Sex, female 398 189 (47.5) Clinical data Systolic blood pressure mmHg 386 130.7±22.0 Diastolic blood pressure mmHg 383 74.5±13.5 Peripheral oxygen saturation % 387 95.3±3.3 Heart rate beats·min−1 381 85.1±18.4 Respiratory frequency breaths·min−1 386 20.3±5.1 Supplementary oxygen doses L·min−1 364 1.7±3.3 Biochemical data Ferritin μg·L−1 175 986.0±1183.6 Haemoglobin mmol·L−1 384 7.7±1.4 C-reactive protein mg·L−1 381 64±66 Leukocytes, count ×109 L−1 385 9.0±5.1 Lymphocytes, count ×109 L−1 374 1.4±1.3 Monocytes, count ×109 L−1 299 0.6±0.4 Neutrophils, count ×109 L−1 379 6.7±4.6 Estimated glomerular filtration rate mL·min−1 272 69.6±23.3 Carbamide mmol·L−1 291 7.2±5.8 Creatinine μmol·L−1 385 98.0±92.3 Natrium mmol·L−1 385 138.5±4.2 Potassium mmol·L−1 382 3.8±0.5 Fibrin D-dimer mg·L−1 (FEU) 263 2.4±4.6 Pro-brain natriuretic peptide ng·L−1 155 706.4±2418.1 Troponin I (HS) ng·L−1 75 211.0±1120.1 Troponin T (HS) ng·L−1 93 68.9±349.1 Glucose mmol·L−1 249 7.4±3.0 Haemoglobin A1c mmol·mol−1 160 44.5±13.2 pH-arterial 301 7.5±0.1 PaCO2 kPa 297 5.0±1.3 PaO2 kPa 132 10.2±3.1 Base excess mmol·L−1 133 1.3±4.8 Hydrogen carbonate mmol·L−1 300 25.2±4.7 Lactate-arterial mmol·L−1 275 1.5±0.9 Ultrasound equipment General Electric's Vivid S60 398 201 (51) General Electric's LogiQ S8 398 151 (38) Sonosite X-porte 398 46 (12) Phased array transducer with cardiography pre-set 398 201 (51) Curvilinear transducer with abdominal pre-set 398 197 (49) Outcome data COVID-19 positive PCR test 398 227 (57) Overall mortality 30 days after admission 398 47 (11.8) COVID-19-related mortality 30 days after admission 398 28 (7) Admission to intensive care 398 21 (5.3) COVID-19-positive admission to intensive care 398 19 (4.8) Ventilator treatment 398 18 (4.9) COVID-19-positive ventilator treatment care 398 17 (4.3) High-flow oxygen treatment 398 56 (14) COVID-19-positive, high-flow oxygen treatment 398 51 (12.8) Nasal oxygen treatment 398 159 (43.3) COVID-19-positive, nasal oxygen treatment 398 117 (29.4) FEU: fibrin-equivalent units; HS: high sensitivity; PaCO2: arterial carbon dioxide tension; PaO2: arterial oxygen tension.
- TABLE 2
Focused lung ultrasound (FLUS) scoring results from the thoracic scannings zones
Scanning zone FLUS score 0. The pleural line is continuous and regular; horizontal artefacts are present 1. The pleural line is indented; below the indent, vertical areas of white are visible 2. The pleural line is broken; below the breaking point, small-to-large consolidated areas appear with associated areas of white below the consolidated area 3. The scanned area shows dense and largely extended white lung with or without larger consolidations Missing; no film recorded or ultrasound not performed in zone Right 1 262 (65.8) 59 (14.8) 45 (11.3) 29 (7.29) 3 (0.75) Right 2 250 (62.8) 80 (20.1) 43 (10.3) 23 (4.8) 2 (0.5) Right 3 185 (45.5) 67 (16.8) 99 (24.9) 22 (8.3) 14 (3.5) Right 4 197 (49.5) 87 (21.9) 69 (17.3) 27 (6.7) 18 (4.5) Right 5 70 (17.6) 30 (7.5) 27 (6.8) 6 (1.5) 265 (66.6) Right 6 98 (24.6) 21 (5.3) 11 (2.8) 2 (0.5) 266 (66.9) Right 7 111 (27.9) 15 (3.8) 4 (1) 2 (0.5) 266 (66.8) Left 1 276 (67.1) 52 (13.1) 50 (12.6) 25 (6.3) 4 (1) Left 2 247 (62.1) 60 (15.1) 60 (15.1) 23(5.8) 8 (2) Left 3 166 (41.7) 74 (18.6) 103 (25.9) 42 (10.6) 13 (3.3) Left 4 200 (50.3) 57 (14.3) 81 (20.3) 39 (9.8) 21 (5.3) Left 5 82 (20.6) 18 (4.5) 23 (5.8) 6 (1.5) 269 (67.6) Left 6 99 (24.9) 18 (4.5) 14 (3.5) 0 (0) 267 (67.1) Left 7 114 (28.6) 11 (2.8) 6 (1.5) 0 (0) 267 (67.1) Data presented as n (%).
- TABLE 3
Uni- and multivariate logistic regression analysis of capability to predict primary outcome and secondary outcomes of median focused lung ultrasound (FLUS) score
Univariate logistic regression Multivariate logistic regression Relative risk SE 95% CI p-value Relative risk SE 95% CI p-value Mechanical ventilation 2.84 0.75 1.69–4.77 <0.001 2.44 0.77 1.31–4.52 0.005 Intensive care unit 2.85 0.73 1.73–4.71 <0.001 2.55 0.76 1.42–4.6 0.002 High-flow oxygen treatment 2.06 0.27 1.59–2.66 <0.001 1.95 0.26 1.5–2.53 <0.001 30-day mortality due to COVID-19 1.77 0.37 1.17–2.67 0.007 1.14 0.29 0.7–1.88 0.601 30-day all-cause mortality 1.51 0.24 1.10–2.06 0.01 0.95 0.22 0.61–1.51 0.853 Age, sex, comorbidity and non-high-flow oxygen treatment are included as covariates in the multivariate analysis. In this analysis FLUS was the only variable that predicted need for mechanical ventilation, admission to intensive care unit and high-flow oxygen treatment. FLUS did not predict 30-day mortality or 30-day mortality due to COVID-19. Age was the only positive predictor for these in a multivariable logistic regression.
- TABLE 4
Uni- and multivariate logistic regression analysis of different focused lung ultrasound (FLUS) scoring systems’ capability to predict need for mechanical ventilation
Univariate logistic regression Multivariate logistic regression Relative risk SE 95% CI p-value Relative risk SE 95% CI p-value Median FLUS score 2.84 0.75 1.69–4.77 <0.001 2.44 0.77 1.31–4.52 0.005 Highest FLUS score in any zone 2.97 1.03 1.5–5.9 0.002 2.22 0.8 1.1–4.51 0.028 FLUS score >3 in any of the zones 5.42 2.67 2.06–14.25 <0.001 3.54 1.84 1.27–9.83 0.015 Count of FLUS zones scoring 3 1.48 0.04 1.4–1.58 <0.001 1.46 0.09 1.29–1.66 <0.001 Count of FLUS zones scoring 2 1.31 0.09 1.14–1.5 <0.001 1.38 0.11 1.18–1.61 <0.001 Median FLUS score, anterior and lateral zones only 2.96 0.76 1.79–4.89 <0.001 2.63 0.77 1.47–4.69 0.001 Total sum of FLUS 1.12 0.02 1.09–1.17 <0.001 1.12 0.03 1.08–1.18 <0.001
Supplementary Material
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Supplementary material 00128-2022.SUPPLEMENT
