Oxygen desaturation and lung ultrasonography as markers of diffuse parenchymal lung diseases severity

Résumé

PURPOSE: we aimed to evaluate lung ultrasound (LUS) and oxygen desaturation as markers for the severity of diffuse parenchymal lung disease (DPLD), specifically the fibrotic subtypes, and correlate the findings with high-resolution computed tomography (HRCT) and other physiologic parameters. METHODS: A case-control study was conducted recruiting 31 DPLD patients and 20 age-matched healthy controls from our institution. All participants had a spirometry, HRCT, 6-minute walk test (6MWT), echocardiography and full-night cardio-respiratory polygraph. LUS for B-line quantification and pleural examination was performed on 6 zones bilaterally. RESULTS: Compared to controls, patients had a statistically significant higher total number of B-lines, lower 6MWT nadir O2 and lower nadir nocturnal oxygen saturation (SpO2). Among patients; fibrotic DPLD (58.1%) had more B-lines, pleural irregularities with or without fragmentation, higher Warrick scores and lower 6MWT nadir SpO2 (p = 0.01, 0.008, < 0.005, 0.03 respectively). There was a statistically significant positive correlation between LUS findings and Warrick score that inversely correlated with the forced vital capacity (FVC)% predicted (p < 0.001). A score of LUS findings, 6MWT nadir SpO2 and time spent with SpO2 < 90% (T90) ≥2 points had a sensitivity of 91.7% and specificity of 66.7% in predicting severe fibrotic DPLD (area under curve (AUC)= 0.832, CI95% = 0.723-0.941, p = 0.001). CONCLUSIONS: The number of B-lines and pleural irregularities in LUS, nocturnal desaturation and exercise desaturation can play a role as markers of DPLD severity.

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