Lung Ultrasound to Assess Pulmonary Congestion in Patients with Acute Exacerbation of COPD

Figures & data

Figure 1 Flow chart of the study population.

Abbreviation: HF, heart failure.

Table 1 Baseline Characteristics of the Total Population, and Stratified by the Presence of Concurrent HF

	Total (n=123)	No Concurrent HF (n=75)	HF Concurrent (n=48)	P-value
Age (years)	75 ± 9	72 ± 9	78 ± 8	<0.001
Male	57 (46%)	31 (41%)	26 (54%)	0.16
Smoking	52 (42%)	34 (45%)	18 (38%)	0.39
Body mass index (kg/m2)	23.8 ± 6.4	23.1 ± 5.1	25.0 ± 7.9	0.11
Lung function before exacerbation
FEV1 > 50%	29 (25%)	15 (21%)	14 (33%)	0.061
FEV1 30–50%	46 (40%)	26 (37%)	20 (47%)
FEV1 < 30%	39 (34%)	30 (42%)	9 (21%)
Comorbidities
Diabetes	16 (13%)	7 (9%)	9 (19%)	0.13
Hypertension	44 (36%)	28 (37%)	16 (33%)	0.65
Acute myocardial infarction	33 (27%)	17 (23%)	16 (33%)	0.19
Atrial fibrillation	20 (16%)	6 (8%)	14 (29%)	0.002
Emphysema	40 (33%)	27 (36%)	13 (27%)	0.30
Medications
RAAS-inhibitors	50 (41%)	25 (33%)	25 (52%)	0.039
Beta Blockers	54 (44%)	25 (33%)	29 (60%)	0.003
Diuretics as regular medicine	52 (42%)	20 (27%)	32 (67%)	<0.001
Diuretics prior to LUS	61 (50%)	25 (33%)	36 (75%)	<0.001
Baseline
Respiration frequency (/min)	27 ± 7	26 ± 6	28 ± 6	0.022
Saturation (%)	89 ± 7	89 ± 7	89 ± 6	0.89
Systolic blood pressure (mmHg)	139 ± 25	137 ± 23	141 ± 27	0.44
Pulse (beats/minute)	95 ± 18	97 ± 17	91 ± 20	0.067
Laboratory values
CRP (ng/L)	20 (7–60)	21 (5–70)	17 (11–47)	0.99
NT-proBNP (ng/L)	455 (125–1247)	125 (39–373)	979 (490–2896)	<0.001
High sensitive Troponin T (ng/L)	30 (18–52)	24 (14–41)	45 (26–58)	<0.001
Creatinine (umol/L)	69 (58–92)	67 (55–87)	75 (59–114)	0.030
Hemoglobin (g/dL)	13.6 ± 1.9	13.9 ± 1.7	13.1 ± 2.0	0.028
Partial pressure oxygen (kPa)	8.8 ± 3.4	9.2 ± 4.1	8.2 ± 1.7	0.098
Chest X-ray
Congestion	36 (30%)	9 (13%)	27 (56%)	<0.001
Infiltrate	29 (24%)	14 (19%)	15 (31%)	0.14
Index hospitalization
Length of stay (days)	5 (3–7)	4 (3–6)	5 (3–10)	0.15

Note: Mean ± standard deviation, n (%) or median (25–75th percentile).

Abbreviations: CRP, C-reactive protein; FEV₁, forced expiratory volume in the 1st second (n=114); HF, heart failure; hs-cTnT, high sensitive cardiac Troponin T (n=106); LUS, lung ultrasound, NT-proBNP, N-terminal pro-B-type natriuretic peptide (n=92); RAAS, renin-angiotensin system antagonist.

Figure 2 Clinical characteristics and findings in association with the total number of B-lines on lung ultrasound (LUS). Presented as a coefficient plot with incidence rate ratio and 95% confidence intervals.

Abbreviations: CRP, C-reactive protein; FEV₁, Forced expiratory volume during 1st second; HF, heart failure; NT-proBNP, N-terminal pro-B-type natriuretic peptide.

Table 2 Hospitalization for Acute Exacerbation of Chronic Obstructive Pulmonary Disease (AECOPD) and All-Cause Death During 12 Months Follow-Up in Patients with and without a Positive Lung Ultrasound (LUS) (≥3 B-Lines in ≥2 Zones Bilaterally)

	Negative LUS (n=107)	Positive LUS (n=16)
Hospitalization for AECOPD	66 (62%)	9 (56%)
All-cause death	15 (14%)	2 (13%)
Hospitalization for AECOPD or all-cause death	81 (76%)	11 (69%)
Cox-regression analysis of time to hospitalization for AECOPD or all-cause death
Unadjusted	Ref	HR 0.98 (95% CI 0.52–1.84) p=0.94
Adjusted for age, sex and forced expiratory volume in the 1st second	Ref	HR 0.93 (95% CI 0.49–1.75) p=0.81

Abbreviations: AECOPD, Acute exacerbation of COPD; AUC, Area under the curve; CHF, chronic heart failure; COPD = chronic obstructive pulmonary disease; CRP, C-reactive protein; CI, confidence interval; FEV1, forced expiratory volume in the 1st second; LUS, lung ultrasound; HF, heart failure; HR, hazard ratio; hs-cTnT, high sensitive cardiac Troponin T; NT-proBNP, N-terminal pro-B-type natriuretic peptide; RAAS, renin-angiotensin system antagonist.

Figure 3 Survival plots for rehospitalization and all-cause mortality in patients with and without a positive lung ultrasound (LUS) during the index hospitalization for acute exacerbation of chronic obstructive pulmonary disorder (AECOPD).