https://doi.org/10.4081/ecj.2026.14986
Prognostic performance of lung ultrasound score in patients presenting to the emergency department with respiratory complaints or suspected infection independent of final diagnosis
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Published: 20 July 2026
In patients presenting to the Emergency Department (ED) with acute respiratory symptoms or suspected infection, Lung Ultrasound (LUS) may serve as a valuable diagnostic tool. Its use and clinical applicability markedly increased since the SARS-CoV-2 pandemic. The aim of this study was to evaluate whether LUS can predict 30-day mortality or Intensive Care Unit (ICU) admission in patients presenting to the ED and to develop a prognostic model. We conducted a bicentric observational cohort in two Italian EDs. Two scores were analyzed, the overall LUS score and the anterolateral LUS score. Multivariable logistic regression models were developed, and their performance was assessed using the area under the receiver operating characteristic curve (Area Under the Curve, AUC) and validated with concordance indices (C-indexes). Four hundred and thirty-four patients were enrolled. The median time from symptom onset to ED presentation was 4 days (IQR 6). The primary final diagnosis was SARS-COV2 infection in 32% of cases, other respiratory diseases in 15%, heart failure in 9%. The composite outcome occurred in 68 patients (15.7%). The empirically estimated AUC of the LUS score was 67%. A prognostic model including age, overall LUS score, time from symptom onset, history of diabetes, chronic kidney disease, and cancer within the previous 5 years showed a C-index of 70.8%. This study suggests that, in patients presenting to the ED with respiratory symptoms, the LUS score may have a prognostic value regardless of the final diagnosis established at the end of the diagnostic work-up performed in the ED.
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CRediT authorship contribution
All authors have given permission and approval for this manuscript to be published, and agree to be accountable for the accuracy and integrity of the work. Peiman Nazerian and Emanuele Pivetta designed the study. Peiman Nazerian, Emanuele Pivetta, Federico Grosso, Alessio Prota, Matteo Oddi, Giulia Silvestri, Paolo Bima, Barbara Casanova, Eleonora de Villa, Eriola Haxhiraj collected the data. Emanuele Pivetta analyzed the data; Peiman Nazerian, Emanuele Pivetta, Federico Grosso, Alessio Prota, Matteo Oddi, Giulia Silvestri, Paolo Bima, Barbara Casanova, Eleonora de Villa, Eriola Haxhiraj, Fulvio Morello, Enrico Lupia interpreted the outcome data. Peiman Nazerian, Alessio Prota, Emanuele Pivetta, Enrico Lupia drafted the manuscript. All authors revised and approved the manuscript.
Data Availability Statement
The datasets used and/or analyzed are available from the corresponding author on reasonable request.
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