Predictive Value of Lung Ultrasound Scoring System in ARDS Severity and Mortality

Background: Acute Respiratory Distress Syndrome (ARDS) is characterized by diffuse alveolar damage leading to hypoxemia and respiratory failure. Accurate bedside assessment of ARDS severity is challenging with conventional imaging. Lung ultrasound (LUS) is emerging as a promising radiation-free, repeatable modality capable of providing real-time lung aeration evaluation. Objective: To evaluate the lung ultrasound scoring system as a predictive tool for clinical severity and 28-day outcomes in patients with ARDS. Methods: In this single-center observational study conducted from January to June 2024, 30 adult patients with ARDS (Berlin criteria) underwent standardized lung ultrasound scoring across 12 thoracic regions. LUS scores were correlated with oxygenation parameters (PaO₂/FiO₂ ratio), need for mechanical ventilation, and 28-day mortality. Statistical analysis included correlation coefficients and receiver operating characteristic (ROC) curve analysis. Results: Lung ultrasound scores demonstrated a moderate to strong inverse correlation with oxygenation (r = -0.69), indicating that higher LUS scores reflect worse gas exchange. Patients who died within 28 days had significantly higher mean LUS scores (22.7 &plusmn; 3.0) than survivors (17.8 &plusmn; 3.9; p < 0.05). ROC analysis yielded an area under the curve (AUC) of 0.84 for predicting mortality, with a cutoff score of ?20 showing 81.6% sensitivity and 71.4% specificity. LUS scores poorly predicted the need for mechanical ventilation (AUC = 0.55). Conclusion: Lung ultrasound scoring is a valuable bedside tool for assessing ARDS severity and predicting 28-day mortality. Implementing LUS can facilitate timely risk stratification and personalized management, reducing reliance on radiation-based imaging.