Lung ultrasound for the early diagnosis of COVID-19 pneumonia: an international multicenter study.
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Volpicelli Giovanni, Gargani Luna, Perlini Stefano, Spinelli Stefano, Barbieri Greta, Lanotte Antonella, Casasola Gonzalo García, Nogué-Bou Ramon, Lamorte Alessandro, Agricola Eustachio, Villén Tomas, Deol Paramjeet Singh, Nazerian Peiman, Corradi Francesco, Stefanone Valerio, Fraga Denise Nicole, Navalesi Paolo, Ferre Robinson, Boero Enrico, Martinelli Giampaolo, Cristoni Lorenzo, Perani Cristiano, Vetrugno Luigi, McDermott Cian, Miralles-Aguiar Francisco, Secco Gianmarco, Zattera Caterina, Salinaro Francesco, Grignaschi Alice, Boccatonda Andrea, Giostra Fabrizio, Infante Marta Nogué, Covella Michele, Ingallina Giacomo, Burkert Julia, Frumento Paolo, Forfori Francesco, Ghiadoni Lorenzo, on behalf of the International Multicenter Study Group on LUS in COVID-19
Аннотация
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.