Torres-Macho, JuanSánchez-Fernández, MarcosArnanz-González, IreneTung-Chen, YaleFranco-Moreno, Ana IsabelDuffort-Falcó, MercedesBeltrán-Romero, LuisRodríguez-Suaréz, SantiagoBernabeu-Wittel, MáximoUrbano, ElenaMéndez-Bailon, ManuelRoque-Rojas, FernandoGarcía-Guijarro, ElenaGarcía-Casasola, Gonzalo2025-01-072025-01-072021-10-202077-0383https://hdl.handle.net/10668/28216The value of serial lung ultrasound (LUS) in patients with COVID-19 is not well defined. In this multicenter prospective observational study, we aimed to assess the prognostic accuracy of serial LUS in patients admitted to hospital due to COVID-19. The serial LUS protocol included two examinations (0-48 h and 72-96 h after admission) using a 10-zones sequence, and a 0 to 5 severity score. Primary combined endpoint was death or the need for invasive mechanical ventilation. Calibration (Hosmer-Lemeshow test and calibration curves), and discrimination power (area under the ROC curve) of both ultrasound exams (SCORE1 and 2), and their difference (DIFFERENTIAL-SCORE) were performed. A total of 469 patients (54.2% women, median age 60 years) were included. The primary endpoint occurred in 51 patients (10.9%). Probability risk tertiles of SCORE1 and SCORE2 (0-11 points, 12-24 points, and ≥25 points) obtained a high calibration. SCORE-2 showed a higher discrimination power than SCORE-1 (AUC 0.72 (0.58-0.85) vs. 0.61 (0.52-0.7)). The DIFFERENTIAL-SCORE showed a higher discrimination power than SCORE-1 and SCORE-2 (AUC 0.78 (0.66-0.9)). An algorithm for clinical decision-making is proposed. Serial lung ultrasound performing two examinations during the first days of hospitalization is an accurate strategy for predicting clinical deterioration of patients with COVID-19.enAttribution 4.0 Internationalhttp://creativecommons.org/licenses/by/4.0/COVID-19lung ultrasoundpneumoniapoint-of-care ultrasoundprognosisresearch article34768337open access10.3390/jcm10214818PMC8584928https://www.mdpi.com/2077-0383/10/21/4818/pdf?version=1634823312https://pmc.ncbi.nlm.nih.gov/articles/PMC8584928/pdf