Imen Trabelsi, Ines Haouala, Amal Ben Hassine, Arij Labiadh, Khaoula Bel Haj Ali, Randa Dhaoui, Marwa Toumia, Adel Sekma, Rahma Jaballah, Lotfi Boukadida, Houda Ben Salah, Asma Zorgati, Kaouthar Beltaief, Houda Ben Soltane, Zied Mezgar, Mariem Khrouf, Insaf Dlala, Samia Bettout, Amira Sghaier, Nahla Jerbi, Amina Chaka, Wahid Bouida, Walid Jomaa, Khaldoun Ben Hamda, Mohamed Habib Grissa, Hamdi Boubaker, Riadh Boukef, Mohamed Amine Msolli, Semir Nouira
Dynamic change of LUS score during hospitalization demonstrated modest predictive accuracy for short-term prognosis in patients with AHF. Integrating ΔLUS into a multimodal assessment strategy combining clinical and other tests such as NT-proBNP may be necessary to optimize post-discharge prognostication in AHF.
BACKGROUND: Persistent pulmonary congestion is a key driver of poor outcomes in acute heart failure (AHF). While lung ultrasonography (LUS) is a validated tool for quantifying congestion, the prognostic utility of its change (ΔLUS) remains uncertain.
OBJECTIVES: This study aimed to evaluate the ability of ΔLUS to predict 30-day risk of death or hospital readmission in patients with AHF.
METHODS: We conducted a prospective observational study in two university hospitals. Consecutive patients with AHF underwent LUS exam within 12 h of emergency department (ED) admission and before discharge. ΔLUS was calculated as the percentage change between baseline and discharge values. The primary endpoint was a composite of all-cause mortality and hospital readmission within 30 days.
RESULTS: Among 814 enrolled patients, the median baseline LUS score was 27 [interquartile rang (IQR) 22-32], decreasing to 21 [15-28] at discharge. The median ΔLUS was 16.7% [IQR 6.3-39.1]. At 30-day, 264 patients (32.4%) met the composite endpoint (110 deaths, 208 readmissions). The discriminative power of ΔLUS for the composite endpoint was modest [Area under curve (AUC) 0.62 (95% CI 0.58-0.66)]. A ΔLUS cutoff of >16% had a sensitivity of 59% and specificity of 64%. The discrimination performance of ΔLUS significantly improved when combined with N-terminal pro-brain natriuretic peptide [AUC 0.82 (95% CI 0.79-0.85)].
CONCLUSION: Dynamic change of LUS score during hospitalization demonstrated modest predictive accuracy for short-term prognosis in patients with AHF. Integrating ΔLUS into a multimodal assessment strategy combining clinical and other tests such as NT-proBNP may be necessary to optimize post-discharge prognostication in AHF.