Observational studyJournal of ultrasound in medicine : official journal of the American Institute of Ultrasound in Medicine2026
A Predictive Model Based on Cardio and Lung Ultrasound Features for Differential Diagnosis of Cardiogenic and Non-cardiogenic Dyspnea in Patients With Chronic Kidney Disease: A Single-Center Observational Study.
Observational study in Journal of ultrasound in medicine : official journal of the American Institute of Ultrasound in Medicine, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
objectivesLung ultrasound (LUS) quantifying B-lines is valuable to assess fluid status during hemodialysis. However, B-lines may indicate not only cardiogenic pulmonary edema (CPE) but also non-cardiogenic pulmonary diseases, such as pneumonia or interstitial lung disease, posing challenges to guiding fluid therapy decisions. We developed a combined cardiac-LUS diagnostic model to differentiate these etiologies, aiming to prevent misdiagnosis and optimize treatment.
methodsThis retrospective observational study enrolled chronic kidney disease (CKD) stage 3-5 patients divided into training and validation cohorts. Participants were classified into CPE group or non-cardiogenic dyspnea (NCD) group. Multivariable logistic regression identified discriminative echocardiographic and LUS parameters to build a diagnostic model. Predictive performance was assessed using receiver operator characteristic (ROC), calibration and decision curve analysis. A simplified β-weighted scoring system was developed and evaluated.
resultsThis retrospective study analyzed 215 training and 56 validation participants. Multivariable regression identified E/e' (OR 1.180, 95% CI 1.067-1.304, p = .001), inferior vena cava diameter (OR 1.240, 95% CI 1.023-1.503, p = .029), bilateral symmetric B-pattern (OR 9.720, 95% CI 2.707-34.899, p < .001), bilateral continuous B-pattern (OR 13.777, 95% CI 3.666-51.770, p < .001), ≥1 irregular pleural line region (OR 0.078, 95% CI 0.018-0.326, p < .001), ≥1 consolidation region (OR 0.039, 95% CI 0.008-0.196, p < .001), ≥1 pleural effusion region (OR 4.732, 95% CI 1.148-19.510, p = .032) as independent CPE predictors. The nomogram showed good discrimination, with area under the curve (AUC) of 0.9703 (training) and 0.8910 (validation). The β-weighted scoring system (cut-off as 42.99 scores) showed an AUC of 0.968 (training) and 0.888 (validation).
conclusionThe nomogram model demonstrated that the ultrasound parameters and β-weighted scoring system possess reliable clinical application value and high predictive accuracy.
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