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Combining lung ultrasound and Wells score for diagnosing pulmonary embolism in critically ill COVID-19 patients

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Název: Combining lung ultrasound and Wells score for diagnosing pulmonary embolism in critically ill COVID-19 patients
Autoři: Viviane Zotzmann, Daniel Duerschmied, Xavier Bemtgen, Alexander Supady, Dawid L. Staudacher, Christoph Bode, Bonaventura Schmid, Corinna N. Lang, Katharina Mueller-Peltzer, Tobias Wengenmayer
Zdroj: J Thromb Thrombolysis
Informace o vydavateli: Springer Science and Business Media LLC, 2020.
Rok vydání: 2020
Témata: Male, Computed Tomography Angiography, Critical Illness, Pulmonary Artery, Multimodal Imaging, Risk Assessment, Article, 03 medical and health sciences, 0302 clinical medicine, Predictive Value of Tests, Risk Factors, Clinical Decision Rules, Humans, Registries, 10. No inequality, Lung, Aged, Retrospective Studies, Ultrasonography, COVID-19, Reproducibility of Results, Middle Aged, 3. Good health, Female, Pulmonary Embolism, SARS-CoV2, Aged [MeSH], Risk Assessment [MeSH], Ultrasonography [MeSH], CTPA, Risk Factors [MeSH], COVID-19/complications [MeSH], Critical Illness [MeSH], Male [MeSH], Computed Tomography Angiography [MeSH], Pulmonary Artery/diagnostic imaging [MeSH], Pulmonary Embolism/diagnostic imaging [MeSH], COVID-19/diagnosis [MeSH], Female [MeSH], Lung ultrasound, Humans [MeSH], Multimodal Imaging [MeSH], Predictive Value of Tests [MeSH], Retrospective Studies [MeSH], Middle Aged [MeSH], Wells score, Lung/diagnostic imaging [MeSH], Clinical Decision Rules [MeSH], Pulmonary embolism, Reproducibility of Results [MeSH], Pulmonary Embolism/etiology [MeSH], Registries [MeSH]
Popis: Subpleural consolidations have been found in lung ultrasound in patients with COVID-19, possibly deriving from pulmonary embolism (PE). The diagnostic utility of impact of lung ultrasound in critical-ill patients with COVID-19 for PE diagnostics however is unclear. We retrospectively evaluated all SARS-CoV2-associated ARDS patients admitted to our ICU between March 8th and May 31th 2020. They were enrolled in this study, when a lung ultrasound and a computed tomography pulmonary angiography (CTPA) were documented. In addition, wells score was calculated to estimate the probability of PE. The CTPA was used as the gold standard for the detection of PE. Twenty out of 25 patients met the inclusion criteria. In 12/20 patients (60%) (sub-) segmental PE were detected by CT-angiography. Lung ultrasound found subpleural consolidations in 90% of patients. PE-typical large supleural consolidations with a size ≥ 1 cm were detectable in 65% of patients and were significant more frequent in patients with PE compared to those without (p = 0.035). Large consolidations predicted PE with a sensitivity of 77% and a specificity of 71%. The Wells score was significantly higher in patients with PE compared to those without (2.7 ± 0.8 and 1.7 ± 0.5, respectively, p = 0.042) and predicted PE with an AUC of 0.81. When combining the two modalities, comparing patients with considered/probable PE using LUS plus a Wells score ≥ 2 to patients with possible/unlikely PE in LUS plus a Wells score 2, this might indicate a high-risk for PE in COVID-19.
Druh dokumentu: Article
Other literature type
Popis souboru: pdf
Jazyk: English
ISSN: 1573-742X
0929-5305
DOI: 10.1007/s11239-020-02323-0
DOI: 10.21203/rs.3.rs-70085/v1
Přístupová URL adresa: https://link.springer.com/content/pdf/10.1007/s11239-020-02323-0.pdf
https://www.researchsquare.com/article/rs-70085/latest.pdf
https://pubmed.ncbi.nlm.nih.gov/33145663
https://link.springer.com/content/pdf/10.1007/s11239-020-02323-0.pdf
https://www.researchsquare.com/article/rs-70085/v1.pdf
https://www.researchsquare.com/article/rs-70085/v1
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7608377
https://pubmed.ncbi.nlm.nih.gov/33145663/
https://khepri-node.dev.meta-infra.org/papers/combining-lung-ultrasound-and-wells-score-for/33145663
https://repository.publisso.de/resource/frl:6468610
Rights: CC BY
URL: http://creativecommons.org/licenses/by/4.0/Open AccessThis article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/ (http://creativecommons.org/licenses/by/4.0/) .
Přístupové číslo: edsair.doi.dedup.....91e6237be15af67079c49683f800f7b2
Databáze: OpenAIRE
Popis
Abstrakt:Subpleural consolidations have been found in lung ultrasound in patients with COVID-19, possibly deriving from pulmonary embolism (PE). The diagnostic utility of impact of lung ultrasound in critical-ill patients with COVID-19 for PE diagnostics however is unclear. We retrospectively evaluated all SARS-CoV2-associated ARDS patients admitted to our ICU between March 8th and May 31th 2020. They were enrolled in this study, when a lung ultrasound and a computed tomography pulmonary angiography (CTPA) were documented. In addition, wells score was calculated to estimate the probability of PE. The CTPA was used as the gold standard for the detection of PE. Twenty out of 25 patients met the inclusion criteria. In 12/20 patients (60%) (sub-) segmental PE were detected by CT-angiography. Lung ultrasound found subpleural consolidations in 90% of patients. PE-typical large supleural consolidations with a size ≥ 1 cm were detectable in 65% of patients and were significant more frequent in patients with PE compared to those without (p = 0.035). Large consolidations predicted PE with a sensitivity of 77% and a specificity of 71%. The Wells score was significantly higher in patients with PE compared to those without (2.7 ± 0.8 and 1.7 ± 0.5, respectively, p = 0.042) and predicted PE with an AUC of 0.81. When combining the two modalities, comparing patients with considered/probable PE using LUS plus a Wells score ≥ 2 to patients with possible/unlikely PE in LUS plus a Wells score 2, this might indicate a high-risk for PE in COVID-19.
ISSN:1573742X
09295305
DOI:10.1007/s11239-020-02323-0