@article {Skaarup00128-2022, author = {S{\o}ren Helbo Skaarup and Rasmus Aagaard and Stig Holm Ovesen and Jesper Weile and Hans Kirkegaard and Caroline Espersen and Mats Christian H{\o}jbjerg Lassen and Kristoffer Grundtvig Skaarup and Stefan Posth and Christian B. Laursen and Ask Bock and Michael Dan Arvig and Tor Biering-S{\o}rensen}, title = {Focused lung ultrasound to predict respiratory failure in patients with symptoms of COVID-19. A multicentre prospective cohort study}, elocation-id = {00128-2022}, year = {2022}, doi = {10.1183/23120541.00128-2022}, publisher = {European Respiratory Society}, abstract = {Background In this study we aimed to assess if a focused lung ultrasound examination predict the need for mechanical ventilation admission to an intensive care unit, high-flow oxygen treatment, death of COVID-19 within 30 days and 30-day all-cause mortality in patients with clinical suspicion of COVID-19 or PCR-verified SARS-CoV-2 infection.Methods A multicenter prospective cohort trial was performed. Film clips from focused lung ultrasound examinations were recorded and rated by blinded observers using different scoring systems. A prediction model was built and used to test relationship between lung ultrasound scores and clinical outcomes. Diagnostic performance of scoring systems was analysed.Results A total of 3889 film clips of 398 patients were analysed. Patients who had any of the outcomes of interest had a significantly higher ultrasound score than those who did not. Multivariable logistic regression analyses showed that lung ultrasound predicts mechanical ventilation (RR 2.44, 95\% CI 1.32{\textendash}5.52), admission to intensive care (RR 2.55, 95\% CI 1.41{\textendash}54.59) and high-flow oxygen treatment (RR 1.95, 95\% CI 1.5{\textendash}2.53) but not survival when adjusting for sex, age and relevant comorbidity. There was no diagnostic difference in AUC-ROC between a scoring system using only anterolateral thorax zones and a scoring system that also included dorsal zones.Conclusion Focused lung ultrasound in patients with clinical suspicion of COVID-19 predicts respiratory failure requiring mechanical ventilation, admission to intensive care units and high-flow oxygen. Thus, focused lung ultrasound may be used to risk stratify patients with COVID-19 symptoms.FootnotesThis manuscript has recently been accepted for publication in the ERJ Open Research. It is published here in its accepted form prior to copyediting and typesetting by our production team. After these production processes are complete and the authors have approved the resulting proofs, the article will move to the latest issue of the ERJOR online. Please open or download the PDF to view this article.Conflict of interest: None of the authors have any conflicts of interest to report.}, URL = {https://openres.ersjournals.com/content/early/2022/08/24/23120541.00128-2022}, eprint = {https://openres.ersjournals.com/content/early/2022/08/24/23120541.00128-2022.full.pdf}, journal = {ERJ Open Research} }