title: A simplified ultrasound-based edema score to assess lung injury and clinical severity in septic patients.
abstract: BACKGROUND
  Lung ultrasound (US) is an excellent tool to assess lung edema in a myriad of different clinical situations. We hypothesized that lung US might also be a good prognostic and management instrument in septic patients, regardless of disease severity.
  
  
  METHODS
  This was a prospective observational cohort study at an urban academic emergency department (ED). Inclusion criteria were as follows: septic patients, at least 18 years old, admitted at the ED of a tertiary hospital. A simplified lung edema scoring system (SLESS) was developed, and 6 thoracic regions were evaluated. Four different lung US patterns were considered, from normal aeration to total consolidation. To evaluate disease severity, the SLESS was compared with the Mortality in Emergency Department Sepsis Score and the third version of the Simplified Acute Physiology Score scoring systems. Aiming to assess the effect of the lung edema in the gas exchange, the SLESS was compared with the Pao2/fraction of inspired oxygen ratio.
  
  
  RESULTS
  Sixty-one patients were enrolled in a 3-month period. The SLESS had a good correlation with the Mortality in Emergency Department Sepsis Score and Simplified Acute Physiology Score (r = 0.53 and r = 0.55, respectively; P < .001 for both) and a negative correlation with the Pao2/fraction of inspired oxygen ratio (r = -0.62; P < .001). The SLESS also showed correlation with the respiratory rate (r = 0.45; P = .0003). The odds ratio for death related to the SLESS was 1.370 (95% confidence interval, 1.109-1.691; P = .0035).
  
  
  CONCLUSIONS
  The SLESS is an easy and practical scoring system. It might be a useful tool to predict severity of disease in sepsis patients. The SLESS might also be able to be correlated with the oxygen exchange.
authors.affiliation: Department of Emergency Medicine, Hospital of the University of Campinas (Unicamp), Campinas, Brazil.
authors.forename: Thiago M
authors.initials: TM
authors.lastname: Santos
authors.forename: Daniel
authors.initials: D
authors.lastname: Franci
authors.forename: Carolina M G
authors.initials: CM
authors.lastname: Coutinho
authors.forename: Diego L
authors.initials: DL
authors.lastname: Ribeiro
authors.forename: Marcelo
authors.initials: M
authors.lastname: Schweller
authors.forename: José R
authors.initials: JR
authors.lastname: Matos-Souza
authors.forename: Marco A
authors.initials: MA
authors.lastname: Carvalho-Filho
mesh_terms: D000328:Adult; D000368:Aged; D015331:Cohort Studies; D004636:Emergency Service, Hospital; D005260:Female; D017052:Hospital Mortality; D006801:Humans; D008168:Lung / Q000000981:diagnostic imaging*; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D011446:Prospective Studies; D011654:Pulmonary Edema / Q000000981:diagnostic imaging* / Q000209:etiology / Q000401:mortality; D018805:Sepsis / Q000150:complications / Q000175:diagnosis* / Q000401:mortality; D012720:Severity of Illness Index; D012772:Shock, Septic / Q000150:complications / Q000175:diagnosis / Q000401:mortality; D014463:Ultrasonography