Lung ultrasound findings in ARDS based on the 2023 global definition: Characteristics and prognostic value of different LUS scores

Objective The primary objective was to describe the distribution characteristics of lung ultrasound (LUS) findings in patients meeting the 2023 global definition of acute respiratory distress syndrome (ARDS). The secondary, exploratory aim was to evaluate the prognostic association of LUS scores with 28-day mortality. Methods This prospective study included 224 patients admitted to the ICU/EICU of Ningxia Medical University General Hospital from January to September 2025. LUS signs (regional/total scores, pleural line abnormalities) were collected within 24 h of admission. Prognostic value was assessed using ROC curve analysis. Results The 28-day mortality rate was 29.46% (66/224). Total LUS aeration score correlated positively with pleural line abnormalities ( r = 0.505, P < 0.001). Survivors showed higher proportions of A-lines and normal pleural lines, while non-survivors had more fused B-lines. Pleural line abnormalities showed the strongest exploratory association with 28-day mortality (AUC = 0.617, 95% CI: 0.550–0.681, P = 0.008). Conclusion Early LUS signs differ significantly between survivors and non-survivors among patients meeting the 2023 ARDS definition. Pleural line abnormalities showed an exploratory association with 28-day mortality, suggesting potential value for bedside risk stratification.This study was registered with the Chinese Clinical Trial Registry (Registration Number:ChiCTR2600117533).