Ultrasound-Derived Lung Aeration Score for Predicting Recovery in Severe Community-Acquired Pneumonia
DOI:
https://doi.org/10.53350/pjmhs02026208.3Keywords:
community-acquired pneumonia; lung ultrasound; lung aeration score; clinical recovery; respiratory failure; prognosisAbstract
Background: Severe community-acquired pneumonia is linked to respiratory failure, long hospital intensive care and significant mortality. Patients not likely to recover can be identified early to provide better surveillance and management. The present study assessed the utility of serial ultrasound-derived lung aeration scores for early clinical recovery prediction.
Methods: This was a prospective observational cohort study of 80 adults with severe community-acquired pneumonia (CAP) from June 2025 to March 2026 at Shalamar Hospital Lahore. Lung ultrasound was done within 24 hours of admission, and assessed after 72 hours with a standardized 12-zone protocol. The scores for each region ranged from 0 to 3 and the scores for all regions were summed, resulting in a total score of 0–36. The primary outcome was clinical recovery at day 7. Receiver operating characteristic analysis and multivariable logistic regression were used to assess predictive performance.
Results: Clinical recovery occurred in 52 patients (65.0%), whereas 28 patients (35.0%) failed to recover. Non-recovered patients had higher admission scores than recovered patients (22.4 ± 4.6 vs 16.8 ± 4.3; p<0.001) and markedly higher day-3 scores (20.1 ± 5.0 vs 10.7 ± 4.6; p<0.001). A day-3 score of >16 had a sensitivity of 82.1%, a specificity of 84.6% and an area under the curve of 0.91, predicting non-recovery. For every 1-point improvement on day-3 score, there was a 31% increase in the odds of non-recovery. It can be used to add to traditional clinical and oxygenation severity assessment.
Conclusion: Loss of lung aeration at 72 hours was highly associated with delayed clinical recovery. Serial lung ultrasound could prove to be a useful bedside tool for early risk-stratification in severe community-acquired pneumonia.
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