Background
Materials and methods
Study population and assessments
Clinical examination
Lung US and US B-line score
AI image processing software for B line detection
Bioimpedance analysis
Statistical analysis
Results
Total (n = 61) | B lines ≥5 (n = 24) | B lines < 5 (n = 37) | p-value | |
---|---|---|---|---|
Gender (male, %) | 35 (57.4) | 11 (18.0) | 24 (39.3) | 0.14 |
Age (year) | 59 ± 11.0 | 57.6 ± 12.2 | 60.0 ± 10.2 | 0.42 |
Body weight (kg, pre-dialysis) | 78.3 ± 17.7 | 78.2 ± 19.3 | 78.4 ± 16.8 | 0.98 |
Height (m, pre-dialysis) | 1.6 ± 0.8 | 1.6 ± 0.1 | 1.6 ± 0.1 | 0.83 |
SBP (mmHg, pre-dialysis) | 148.7 ± 20.9 | 155.0 ± 19.4 | 144.6 ± 21.1 | 0.06 |
DBP (mmHg, pre-dialysis) | 74.1 ± 16.2 | 74.4 ± 13.5 | 73.9 ± 17.9 | 0.9 |
SpO2 (%, pre-dialysis) | 96.9 ± 2.2 | 96.1 ± 2.0 | 97.5 ± 2.1 | 0.01 |
O2 requirement (L/min, pre-dialysis) | 0.8 ± 1.2 | 1.1 ± 1.4 | 0.6 ± 1.0 | 0.09 |
Albumin (g/dL, pre-dialysis) | 32.4 ± 5.0 | 30.5 ± 5.2 | 33.7 ± 4.6 | 0.01 |
Body weight (kg, post-dialysis) | 76.8 ± 17.1 | 75.4 ± 19.1 | 77.7 ± 16.0 | 0.66 |
SBP (mmHg, postdialysis) | 149.8 ± 22.5 | 154.5 ± 22.8 | 147.0 ± 22.1 | 0.25 |
DBP (mmHg, postdialysis) | 73.2 ± 15.3 | 72.3 ± 14.7 | 73.8 ± 15.9 | 0.75 |
SpO2 (mmHg, postdialysis) | 95.6 ± 13.7 | 97.1 ± 2.4 | 94.7 ± 17.3 | 0.56 |
Echocardiogram EF (%) | 49.3 ± 12.1 | 49.2 ± 12.4 | 49.5 ± 12.1 | 0.93 |
Clinical examination | 0.001 | |||
Euvolaemic (%) | 6 (9.8) | 5 (8.2) | 1 (1.6) | |
Mild fluid overload (%) | 28 (45.9) | 5 (8.2) | 23 (37.7) | |
Moderate fluid overload (%) | 26 (42.6) | 17 (27.9) | 9 (14.8) | |
Severe fluid overload (%) | 1 (1.6) | 1 (1.6) | 0 (0.0) | |
Haemodialysis | Total (n = 50) | B lines ≥ 5 (n = 19) | B lines < 5 (n = 31) | |
OH (L, pre-dialysis) | 5.2 ± 5.1 | 7.5 ± 6.6 | 3.7 ± 3.2 | 0.01 |
OH (%, pre-dialysis) | 20.6 ± 13.5 | 27.9 ± 13.7 | 16.0 ± 11.4 | 0.003 |
V urea (L, pre-dialysis) | 39.3 ± 12.7 | 40.9 ± 16.2 | 38.1 ± 10.1 | 0.52 |
BMI (kg/m2, pre-dialysis) | 29.7 ± 6.5 | 29.5 ± 7.3 | 29.7 ± 6.2 | 0.92 |
TBW (L, pre-dialysis) | 41.8 ± 12.8 | 43.7 ± 16.3 | 40.6 ± 10.3 | 0.43 |
ECW (L, pre-dialysis) | 21.6 ± 6.8 | 23.5 ± 8.9 | 20.5 ± 5.0 | 0.14 |
ICW (L, pre-dialysis) | 20.3 ± 6.9 | 20.3 ± 8.2 | 20.3 ± 6.0 | 0.99 |
E/I (pre-dialysis) | 1.1 ± 0.2 | 1.2 ± 0.2 | 1.0 ± 0.1 | 0.003 |
OH (L, post-dialysis) | 3.8 ± 5.0 | 6.0 ± 6.6 | 2.5 ± 3.1 | 0.02 |
OH (%, post-dialysis) | 15.4 ± 15.1 | 22.7 ± 15.2 | 11.0 ± 13.4 | 0.007 |
V urea (L, post-dialysis) | 38.8 ± 12.4 | 39.4 ± 15.8 | 38.4 ± 10.0 | 0.77 |
BMI (kg/m2, post-dialysis) | 28.9 ± 6.3 | 28.6 ± 7.0 | 29.0 ± 6.0 | 0.81 |
TBW (L, post-dialysis) | 40.8 ± 12.6 | 41.9 ± 15.9 | 40.2 ± 10.4 | 0.65 |
ECW (L, post-dialysis) | 20.4 ± 6.6 | 21.7 ± 8.6 | 19.6 ± 5.0 | 0.3 |
ICW (L, post-dialysis) | 20.8 ± 7.6 | 20.8 ± 9.7 | 20.9 ± 6.1 | 0.96 |
E/I (post-dialysis) | 1.0 ± 0.2 | 1.1 ± 0.2 | 0.9 ± 0.1 | 0.001 |
Peritoneal dialysis* | Total (n = 11) | B line ≥ 5 (n = 5) | B line < 5 (n = 6) | |
OH (L) | 5.0 ± 6.7 | 8.8 ± 6.1 | 1.9 ± 5.9 | 0.09 |
OH % | 19.7 ± 27.6 | 32.1 ± 15.5 | 9.4 ± 32.4 | 0.19 |
V urea (L) | 42.2 ± 12.9 | 43.7 ± 15.6 | 40.9 ± 12.5 | 0.74 |
BMI (kg/m2) | 28.7 ± 6.8 | 29.8 ± 7.5 | 27.7 ± 6.8 | 0.64 |
TBW (L) | 44.7 ± 12.4 | 46.6 ± 14.7 | 43.2 ± 11.3 | 0.67 |
ECW (L) | 22.1 ± 6.2 | 25.1 ± 8.2 | 19.6 ± 2.8 | 0.16 |
ICW (L) | 22.6 ± 8.9 | 21.5 ± 6.8 | 23.6 ± 10.8 | 0.72 |
E/I | 1.0 ± 0.2 | 1.2 ± 0.1 | 0.9 ± 0.3 | 0.12 |
LUS and the correlations with clinical examination and BIA
Prediction of fluid overload by LUS B lines
Prediction of fluid overload by physician versus AI count of B lines on LUS
Sensitivity | Specificity | Positive predictive value | Negative predictive value | Accuracy | ||
---|---|---|---|---|---|---|
Physician count | OH > = 4.5 | 0.639 | 0.657 | 0.479 | 0.787 | 0.651 |
AI count | OH > = 4.5 | 0.636 | 0.662 | 0.457 | 0.803 | 0.654 |
Physician count | OH > = 4.75 | 0.639 | 0.699 | 0.511 | 0.797 | 0.679 |
AI count | OH > = 4.75 | 0.658 | 0.707 | 0.511 | 0.815 | 0.691 |
Physician count | OH > = 5 | 0.583 | 0.712 | 0.5 | 0.776 | 0.67 |
AI count | OH > = 5 | 0.576 | 0.716 | 0.475 | 0.791 | 0.673 |
Physician count | OH > =4.5 + clinical | 0.76 | 0.655 | 0.396 | 0.902 | 0.679 |
AI count | OH > =4.5 + clinical | 0.833 | 0.621 | 0.217 | 0.967 | 0.645 |
Physician count | OH > =4.75 + clinical | 0.76 | 0.69 | 0.422 | 0.906 | 0.706 |
AI count | OH > =4.75 + clinical | 0.833 | 0.653 | 0.233 | 0.969 | 0.673 |
Physician count | OH > =5 + clinical | 0.72 | 0.714 | 0.429 | 0.896 | 0.716 |
AI count | OH > =5 + clinical | 0.75 | 0.674 | 0.255 | 0.955 | 0.682 |