Accuracy of preoperative lung ultrasound score for the prediction of major adverse cardiac events in elderly patients undergoing HIP surgery under spinal anesthesia: The LUSHIP multicenter observational prospective study
Authors' conclusion
The preoperative LUS score, with its high negative predictive value, could improve patients' risk stratification when used alone or add further value to the RCRI score.
Study context
- Population
- Patients aged >65 years with hip fracture needing urgent surgery, 11 Italian hospitals; excluded major adverse cardiovascular events (MACE) in previous 6 months or ongoing acute HF
- Participants
- 877 patients · 11 Italian hospitals
- Comparison
- Preoperative lung ultrasound scores (LUS) score vs Revised Cardiac Risk Index (RCRI), National Surgical Quality Improvement Program Myocardial infarction and Cardiac arrest (NSQIP-MICA) and American Society of Anesthesiologists Physical Status (ASA-PS) for predicting MACE
- Outcome
- Accuracy of preoperative LUS score for predicting MACE
Methodological detailsmulticentre, ROC curve analysis and comparison, Preoperative LUS obtained by trained anesthesiologists during preoperative evaluation
- Multicentre
- ROC curve analysis and comparison
- Preoperative LUS obtained by trained anesthesiologists during preoperative evaluation
Performance
As reported in the abstract
Prediction of MACE
| Test or model | AUC | Accuracy | Sensitivity | Specificity | NPV |
|---|---|---|---|---|---|
| LUS score ≥8 | 0.78 | 0.76 | 0.71 | 0.76 | 0.95 |
LUS score ≥8
AUC0.78
Accuracy0.76
Sensitivity0.71
Specificity0.76
NPV0.95
- LUS score ≥8 vs RCRI: P < 0.001 — better AUC and accuracy for LUS
- LUS score ≥8 vs MICA: P = 0.001 — better AUC and accuracy for LUS
- LUS score ≥8 vs ASA-PS: P < 0.001 — better AUC and accuracy for LUS
Further findings
MACE with LUS score ≥8 (multivariate analysis)
| OR (95% CI) | ||
|---|---|---|
| LUS score ≥8Multivariate analysis | 5.81 (3.55–9.69) | |
| 0.10.31310Odds ratio (log scale) |
| Outcome | Complicated | Non-complicated | P value |
|---|---|---|---|
| LUS score in complicated vs non-complicated patients | 11.6 ± 6.64 | 4.97 ± 4.90 | P < 0.001 |
MACE incidence
- 108 MACE events in 98 patients; overall incidence
- 11.2%
Postoperative pneumonia
- Patients with postoperative pneumonia
- 91 (10.4%)
- Preoperative LUS score higher in the non-pneumonia group, p < 0.001
Original publication
Accuracy of preoperative lung ultrasound score for the prediction of major adverse cardiac events in elderly patients undergoing HIP surgery under spinal anesthesia: The LUSHIP multicenter observational prospective study. Anaesth Crit Care Pain Med. Published 5 October 2024. doi:10.
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