Gary Duclos1, Florian Bazalguette2, Bernard Allaouchiche3,4,5, Neyla Mohammedi6, Alexandre Lopez6, Mathieu Gazon7, Guillaume Besch8,9, Lionel Bouvet10,11, Laurent Muller2, Gauthier Mathon3, Charlotte Arbelot6, Mohamed Boucekine12, Marc Leone6, Laurent Zieleskiewicz6,13. 1. Department of Anesthesiology and Intensive Care Unit, Aix Marseille University, Assistance Publique Hôpitaux de Marseille, Nord Hospital, Marseille, France. gary.duclos@ap-hm.fr. 2. CHU de Nîmes-Caremeau, Service Réanimation et Surveillance Continue, Pôle ARDU (anesthésie, réanimation, douleur, urgences), 30029, Nîmes cedex, France. 3. Hospices Civils de Lyon, Centre Hospitalier Lyon-Sud, Service de Réanimation, 69310, Pierre-Bénite, France. 4. Université Claude, Bernard-Lyon-1, Lyon, France. 5. Université de Lyon, VetAgro Sup, Campus Vétérinaire de Lyon, UPSP 2016.A101, Pulmonary and Cardiovascular Agression in Sepsis APCSe, 69280, Marcy l'Étoile, France. 6. Department of Anesthesiology and Intensive Care Unit, Aix Marseille University, Assistance Publique Hôpitaux de Marseille, Nord Hospital, Marseille, France. 7. Département d'Anesthésie et Réanimation and Centre de Recherche Clinique, Groupement Hospitalier Nord, Hospices Civils de Lyon, Lyon, France. 8. Department of Anesthesiology and Intensive Care Medicine, University Hospital of Besancon, Besancon, France. 9. EA 3920, University of Franche-Comte, Besancon, France. 10. Service d'Anesthésie Réanimation, Groupement Hospitalier Est, Hospices Civils de Lyon, Lyon, France. 11. Université de Lyon, VetAgro Sup, Campus Vétérinaire de Lyon, UPSP 2016.A101, Pulmonary and Cardiovascular Aggression in Sepsis, 69280, Marcy l'Étoile, France. 12. Centre d'Etudes et de Recherches Sur Les Services de Santé et Qualité, Faculté de Médecine, Aix-Marseille université, Marseille, France. 13. Center for Cardiovascular and Nutrition Research (C2VN), Aix Marseille University, INSERM, INRA, Marseille, France.
Abstract
INTRODUCTION: Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) outbreaks have led to massive admissions to intensive care units (ICUs). An ultrasound examination of the thorax is widely performed on admission in these patients. The primary objective of our study was to assess the performance of the lung ultrasound score (LUS) on ICU admission to predict the 28-day mortality rate in patients with SARS-CoV-2. The secondary objective was to asses the performance of thoracic ultrasound and biological markers of cardiac injury to predict mortality. METHODS: This multicentre, retrospective, observational study was conducted in six ICUs of four university hospitals in France from 15 March to 3 May 2020. Patients admitted to ICUs because of SARS-CoV-2-related acute respiratory failure and those who received an LUS examination at admission were included. The area under the receiver-operating characteristics (ROC) curve was determined for the LUS score to predict the 28-day mortality rate. The same analysis was performed for the Simplified Acute Physiology Score, left ventricular ejection fraction, cardiac output, brain natriuretic peptide and ultra-sensitive troponin levels at admission. RESULTS: In 57 patients, the 28-day mortality rate was 21%. The area under the ROC curve of the LUS score value on ICU admission was 0.68 [95% CI 0.54-0.82; p = 0.05]. In non-intubated patients on ICU admission (n = 40), the area under the ROC curves was 0.84 [95% CI 0.70-0.97; p = 0.005]. The best cut-off of 22 corresponded to 85% specificity and 83% sensitivity. CONCLUSIONS: LUS scores on ICU admission for SARS-CoV-2 did not efficiently predict the 28-day mortality rate. Performance was better for non-intubated patients at admission. Performance of biological cardiac markers may be equivalent to the LUS score.
INTRODUCTION:Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) outbreaks have led to massive admissions to intensive care units (ICUs). An ultrasound examination of the thorax is widely performed on admission in thesepatients. The primary objective of our study was to assess the performance of the lung ultrasound score (LUS) on ICU admission to predict the 28-day mortality rate in patients with SARS-CoV-2. The secondary objective was to asses the performance of thoracic ultrasound and biological markers of cardiac injury to predict mortality. METHODS: This multicentre, retrospective, observational study was conducted in six ICUs of four university hospitals in France from 15 March to 3 May 2020. Patients admitted to ICUs because of SARS-CoV-2-related acute respiratory failure and those who received an LUS examination at admission were included. The area under the receiver-operating characteristics (ROC) curve was determined for the LUS score to predict the 28-day mortality rate. The same analysis was performed for the Simplified Acute Physiology Score, left ventricular ejection fraction, cardiac output, brain natriuretic peptide and ultra-sensitive troponin levels at admission. RESULTS: In 57 patients, the 28-day mortality rate was 21%. The area under the ROC curve of the LUS score value on ICU admission was 0.68 [95% CI 0.54-0.82; p = 0.05]. In non-intubated patients on ICU admission (n = 40), the area under the ROC curves was 0.84 [95% CI 0.70-0.97; p = 0.005]. The best cut-off of 22 corresponded to 85% specificity and 83% sensitivity. CONCLUSIONS: LUS scores on ICU admission for SARS-CoV-2 did not efficiently predict the 28-day mortality rate. Performance was better for non-intubated patients at admission. Performance of biological cardiac markers may be equivalent to the LUS score.