Predictive value of lung ultrasonography on adjusted therapeutic regimen for patients with pneumonia

doi:10.3969/j.issn.1004-583X.2022.02.007

Abstract

Abstract:

Objective To explore the clinical value of pulmonary ultrasonography on adjusted anti-infection therapeutic regimen for patients with pneumonia.Methods Ninety six patients with pneumonia admitted to the Department of Respiratory Medicine of the 967 Hospital of the People's Liberation Army from December 1, 2019 to February 28, 2021 were recorded consecutively; and lung ultrasound scores (LUS), high-sensitivity C-reactive protein (hs-CRP), white blood cell count (WBC), neutrophil percentage (NEU%), clinical symptoms and antibiotic treatment regimen were recorded respectively on admission and the 3^rd Day of treatment. Patients were divided into adjusted group and unadjusted group based on adjusted antibiotics on the 3^rd Day of treatment. The change in LUS on admission and the 3^rd Day of treatment were compared in groups, and the factors of adjustments on antibiotics were analyzed. Patients were divided into two groups including the ΔLUS≥0 group and ΔLUS<0 group based on the difference in change of LUS (ΔLUS) on the 3 ^rd Day, and the prognosis of patients in two groups was observed. Results (1) LUS of patients in the adjusted antibiotics group increased after treatment, while the unadjusted group decreased. The difference in LUS between groups before treatment was statistically significant (P=0.089), the difference on the 3^rd Day of treatment was statistically significant (P<0.05). (2) Logistic regression analysis showed that ΔLUS (P=0.000; OR=1.563, 95%CI: 1.229-1.987) and difference in hs-CRP (Δhs-CRP)(P=0.001; OR=1.045, 95%CI: 1.018-1.074) were associated with antibiotic adjustment. (3) The predictive value of ΔLUS on antibiotic adjustment was analyzed by receiver operating characteristic (ROC) curve. The results showed the sensitivity, specificity, and the area under ROC curve (AUC) were 81.3%, 82.8%, and 0.806, respectively. AUC was 0.901 after combination of ΔLUS and Δhs-CRP, being greater than ΔLUS and Δhs-CRP, and the predictive value was higher. Conclusion Pulmonary ultrasonography is eligible to be used as one of auxiliary references for adjusted therapeutic regimen, and it is more effective to adjust the therapeutic regimen of pneumonia patients by combining hs-CRP.

Key words: pneumonia, lung ultrasound score, treatment

CLC Number:

R563.1

Yu Xin, Liu Zhongyang. Predictive value of lung ultrasonography on adjusted therapeutic regimen for patients with pneumonia[J]. Clinical Focus, 2022, 37(2): 133-136.

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https://huicui.hebmu.edu.cn/EN/Y2022/V37/I2/133

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References 20

[1]	Jain V, Vashisht R, Yilmaz G, et al. Pneumonia Pathology[EB/OL]. [Updated 2021 Aug 4]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2022 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK526116/
[2]	Modi AR, Kovacs CS. Community-acquired pneumonia: Strategies for triage and treatment[J]. Cleve Clin J Med, 2020,87(3):145-151. doi: 10.3949/ccjm.87a.19067 URL
[3]	Ramirez JA, Wiemken TL, Peyrani P, et al. Adults hospitalized with pneumonia in the united states: Incidence, epidemiology, and mortality[J]. Clin Infect Dis, 2017,65(11):1806-1812. doi: 10.1093/cid/cix647 pmid: 29020164
[4]	Metlay JP, Waterer GW, Long AC, et al. Diagnosis and treatment of adults with community-acquired pneumonia. An official clinical practice guideline of the American Thoracic Society and Infectious Diseases Society of America[J]. Am J Respir Crit Care Med, 2019,200(7):e45-e67. doi: 10.1164/rccm.201908-1581ST URL
[5]	Radzina M, Biederer J. Ultrasonography of the lung[J]. Rofo, 2019,191(10):909-923. doi: 10.1055/a-0881-3179 pmid: 30947352
[6]	D'Amato M, Rea G, Carnevale V, et al. Assessment of thoracic ultrasound in complementary diagnosis and in follow up of community-acquired pneumonia (cap)[J]. BMC Med Imaging, 2017,17(1):52. doi: 10.1186/s12880-017-0225-5 pmid: 28859628
[7]	Sperandeo M, Carnevale V, Muscarella S, et al. Clinical application of transthoracic ultrasonography in inpatients with pneumonia[J]. Eur J Clin Invest, 2011,41(1):1-7. doi: 10.1111/j.1365-2362.2010.02367.x pmid: 20731700
[8]	Allinovi M, Parise A, Giacalone M, et al. Lung ultrasound may support diagnosis and monitoring of COVID-19 pneumonia[J]. Ultrasound Med Biol, 2020,46(11):2908-2917. doi: S0301-5629(20)30333-1 pmid: 32807570
[9]	瞿介明, 曹彬. 中国成人社区获得性肺炎诊断和治疗指南(2016年版)[J]. 中华结核和呼吸杂志, 2016,39(4):253-279.
[10]	Mojoli F, Bouhemad B, Mongodi S, et al. Lung ultrasound for critically Ⅲ patients[J]. Am J Respir Crit Care Med, 2019,199(6):701-714. doi: 10.1164/rccm.201802-0236CI URL
[11]	Fine MJ, Auble TE, Yealy DM, et al. A prediction rule to identify low-risk patients with community-acquired pneumonia[J]. N Engl J Med, 1997,336(4):243-250. doi: 10.1056/NEJM199701233360402 URL
[12]	Prina E, Ranzani OT, Torres A. Community-acquired pneumonia[J]. Lancet, 2015,386(9998):1097-1108. doi: 10.1016/S0140-6736(15)60733-4 URL
[13]	Barlow GD, Lamping DL, Davey PG, et al. Evaluation of outcomes in community-acquired pneumonia: A guide for patients, physicians, and policy-makers[J]. Lancet Infect Dis, 2003,3(8):476-488. pmid: 12901890
[14]	Volpicelli G. Lung sonography[J]. J Ultrasound Med, 2013,32(1):165-171. pmid: 23269722
[15]	Lichtenstein D, Mézière G, Biderman P, et al. The comet-tail artifact. An ultrasound sign of alveolar-interstitial syndrome[J]. Am J Respir Crit Care Med, 1997,156(5):1640-1646. doi: 10.1164/ajrccm.156.5.96-07096 URL
[16]	Nazerian P, Volpicelli G, Vanni S, et al. Accuracy of lung ultrasound for the diagnosis of consolidations when compared to chest computed tomography[J]. Am J Emerg Med, 2015,33(5):620-625. doi: 10.1016/j.ajem.2015.01.035 pmid: 25758182
[17]	Mongodi S, Bouhemad B, Orlando A, et al. Modified Lung Ultrasound Score for assessing and monitoring pulmonary aeration[J]. Ultraschall Med, 2017,38(5):530-537. doi: 10.1055/s-0042-120260 pmid: 28291991
[18]	Inchingolo R, Copetti R, Smargiassi A, et al. Air bronchogram integrated lung ultrasound score to monitor community-acquired pneumonia in a pilot pediatric population[J]. J Ultrasound, 2021,24(2):191-200. doi: 10.1007/s40477-020-00547-7 pmid: 33409860
[19]	Dargent A, Chatelain E, Si-Mohamed S, et al. Lung ultrasound score as a tool to monitor disease progression and detect ventilator-associated pneumonia during COVID-19-associated ARDS[J]. Heart Lung, 2021,50(5):700-705. doi: 10.1016/j.hrtlng.2021.05.003 URL
[20]	王倩倩, 蔚文龙, 宋先斌, 等. 超声对危重病患者肺炎治疗效果的评估价值[J]. 中华急诊医学杂志, 2020,29(2):275-278.

特征	抗生素调整组 (n=32)	抗生素未调整组 (n=64)	χ²/t值	P值
年龄(岁)	44.69±25.97	49.13±23.82	-0.723	0.469
性别(男/女,例)	20/12	48/16	1.613	0.204
hs-CRP(mg/L)	46.91±50.99	56.88±82.03	-0.264	0.792
WBC(×10⁹/L)	8.50±5.65	7.37±3.29	-0.054	0.957
NEU%(%)	63.22±15.29	67.41±12.70	-1.329	0.184
症状(例)
咳嗽	25	58	1.880	0.170
咳痰	27	53	0.038	0.846
发热	19	35	0.190	0.663
乏力	10	19	0.025	0.875
胸闷气短	12	24	0.000	1.000
PSI分级(例)
低危组中高危组	24 8	49 15	0.029	0.866

特征	抗生素调整组 (n=32)	抗生素未调整组 (n=64)	χ²/t值	P值
年龄(岁)	44.69±25.97	49.13±23.82	-0.723	0.469
性别(男/女,例)	20/12	48/16	1.613	0.204
hs-CRP(mg/L)	46.91±50.99	56.88±82.03	-0.264	0.792
WBC(×10⁹/L)	8.50±5.65	7.37±3.29	-0.054	0.957
NEU%(%)	63.22±15.29	67.41±12.70	-1.329	0.184
症状(例)
咳嗽	25	58	1.880	0.170
咳痰	27	53	0.038	0.846
发热	19	35	0.190	0.663
乏力	10	19	0.025	0.875
胸闷气短	12	24	0.000	1.000
PSI分级(例)
低危组中高危组	24 8	49 15	0.029	0.866

组别	例数	LUS评分
组别	例数	治疗前	治疗第3天
抗生素调整组	32	6.28±2.87	7.41±3.24
抗生素未调整组	64	5.33±2.76	3.37±3.53
t值		-1.703	-4.966
P值		0.089	0.000

组别	例数	LUS评分
组别	例数	治疗前	治疗第3天
抗生素调整组	32	6.28±2.87	7.41±3.24
抗生素未调整组	64	5.33±2.76	3.37±3.53
t值		-1.703	-4.966
P值		0.089	0.000

变量	β 值	S值	Wald χ²值	P值	OR值	95%CI
变量	β 值	S值	Wald χ²值	P值	OR值	下限	上限
Δhs-CRP(mg/L)	0.044	0.014	10.555	0.001	1.045	1.018	1.074
ΔNEU%	0.019	0.023	0.639	0.424	1.019	0.973	1.067
ΔWBC(×10⁹/L)	-0.072	0.093	0.593	0.441	0.931	0.775	1.117
ΔLUS	0.447	0.122	13.302	0.000	1.563	1.229	1.987
常量	-0.257	0.330	0.607	0.436	0.773