Value of lung ultrasound score change as a predictor of 30-day outcome in acute heart failure: A prospective multicenter study.

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.