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      Predicción de evolución desfavorable en pacientes hospitalizados por COVID-19 mediante ecografía pulmonar Translated title: Lung ultrasound to predict unfavorable progress in patients hospitalized for Covid-19

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          Abstract

          Objetivo: La ecografía torácica (ET) ha mostrado ser útil para el diagnóstico de la afectación pulmonar por COVID-19. Para cuantificar el grado de afectación se han descrito varios scores, aunque no existe evidencia de si su determinación podría tener alguna capacidad predictiva de evolución desfavorable.

          Metodología Estudio prospectivo de cohortes en el que se incluyeron pacientes ingresados por COVID-19. La muestra se estratificó en función de la evolución clínica, considerándose desfavorable en los pacientes que precisaron soporte respiratorio invasivo o no invasivo. Se analizaron biomarcadores al ingreso y el mismo día de la ET, así como las escalas pronósticas al ingreso. Según la posibilidad de sedestación o no se realizó el score ecográfico en 8 o 14 áreas.

          Resultados: Se incluyeron 44 pacientes, 13 (29,5%) con necesidad posterior de soporte ventilatorio. En todos se exploraron 8 áreas y en 35 (79,5%) las 14. Las zonas más afectadas fueron los lóbulos inferiores a nivel posterior. Se detectaron diferencias significativas entre los dos grupos en las escalas multidimensionales SOFA y quick SOFA, la PCR y LDH del mismo día de la ET y la puntuación de los scores ecográficos. La mejor área bajo la curva ROC (AUC), se obtuvo con el score de 14 áreas, siendo de 0,88 (IC95%: 0,75-0,99). Su sensibilidad y especificidad para un punto de corte 13,5 fue de 100% y 61,5%.

          Conclusiones: El uso de scores para cuantificar la afectación pulmonar mediante ET, proporciona información útil para facilitar la estratificación del riesgo en los pacientes hospitalizados con COVID-19.

          Translated abstract

          Objective: Thoracic ultrasound (TUS) has been shown to be useful in the diagnosis of Covid-19 pulmonary involvement. Several scores for quantifying the degree of involvement have been described, although there is no evidence to show that they have any capacity for predicting unfavorable progress.

          Methodology Prospective cohort study of patients hospitalized for Covid-19. The sample was stratified according to clinical course, and patients requiring invasive or non-invasive respiratory support were classified as having unfavorable progress. Biomarkers were analyzed at admission and on the same day that TUS was performed. Prognostic scales were also determined at admission. The ultrasound score was obtained in 8 or 14 areas, depending on the patient's ability to sit.

          Results: We included 44 patients, 13 (29,5%) of whom subsequently needed ventilatory support. Eight areas were explored in all patients and 14 areas in 35 (79.5%). The most affected areas were the posterior lower lobes. Significant differences were found between the two groups on the SOFA and quick SOFA multidimensional scales, and PCR and LDH on the same day as TUS, and the ultrasound scores. The best area under the ROC curve (AUC) was obtained with the 14-area score, with a result of 0.88 (95% CI: 0.75-0.99). Its sensitivity and specificity for a cut-off score of 13.5 were 100% and 61.5%, respectively.

          Conclusions: The use of scores to quantify lung involvement measured by TUS provides useful information, facilitating risk stratification in patients hospitalized with Covid-19.

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          Author and article information

          Journal
          Arch Bronconeumol
          Arch. Bronconeumol
          Archivos De Bronconeumologia
          SEPAR. Published by Elsevier España, S.L.U.
          0300-2896
          1579-2129
          21 September 2020
          21 September 2020
          Affiliations
          [1 ]Hospital Álvaro Cunqueiro. Vigo. Departamento de Neumología. Neumo Vigo I + i. Instituto de Investigación Sanitaria Galicia Sur (IISGS), España
          [2 ]Hospital Álvaro Cunqueiro. Vigo. Departamento de Medicina Interna, España
          Author notes
          [* ]Autor de correspondencia: Neumo Vigo I + i. Instituto de Investigación Sanitaria Galicia Sur (IISGS). Xerencia de Xestión integrada de Vigo, C/ Clara Campoamor 341, 36312 Vigo, Pontevedra, España
          Article
          S0300-2896(20)30299-4
          10.1016/j.arbres.2020.07.043
          7505546
          33067026
          54d99404-a994-4620-9c95-6f5a40c82ec5
          © 2020 SEPAR. Published by Elsevier España, S.L.U. All rights reserved.

          Since January 2020 Elsevier has created a COVID-19 resource centre with free information in English and Mandarin on the novel coronavirus COVID-19. The COVID-19 resource centre is hosted on Elsevier Connect, the company's public news and information website. Elsevier hereby grants permission to make all its COVID-19-related research that is available on the COVID-19 resource centre - including this research content - immediately available in PubMed Central and other publicly funded repositories, such as the WHO COVID database with rights for unrestricted research re-use and analyses in any form or by any means with acknowledgement of the original source. These permissions are granted for free by Elsevier for as long as the COVID-19 resource centre remains active.

          History
          : 25 May 2020
          : 28 July 2020
          Categories
          Original

          covid-19,sars-cov-2,et,ecografía,thoracic ultrasound,ultrasonography

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