Prognostic value of lung ultrasound (B-Line) in pre-discharge as a predictor of 90 days rehospitalization in patient with reduced ejection fraction

Abstract

Objectives. This study aimed to evaluate the prognostic value of pre-discharge lung ultrasound B-line quantification in predicting 90-day rehospitalization among patients with heart failure with reduced ejection fraction (HFrEF). Materials and methods. A retrospective cohort study was conducted at the Integrated Heart Center of Wahidin Sudirohusodo Hospital, including 120 patients with HFrEF hospitalized between March and July 2023. Adult patients (≥18 years) with left ventricular ejection fraction <50% were included, while those undergoing cardiac interventions or with pericardial disease were excluded. Pre-discharge B-lines were quantified across eight lung zones using a Philips Lumify ultrasound device. The primary endpoint was heart failure–related rehospitalization within 90 days. Statistical analyses included receiver operating characteristic curve analysis using the Youden index to determine optimal B-line cutoffs and multivariate logistic regression for risk stratification. Outcomes. Of the 120 patients (mean age 58.6 ± 12.3 years, 73.3% male), 42.5% experienced rehospitalization. Rehospitalized patients had significantly higher B-line counts (26.2 ± 8.1 vs. 19.0 ± 8.5; p < 0.0001). A B-line cutoff of ≥20 predicted rehospitalization with 78.4% sensitivity and 68.1% specificity (AUC 72.2%), conferring a 7.2-fold increased risk (OR 7.216, 95% CI 3.091–16.846). Additional predictors included estimated glomerular filtration rate <63 mL/min/1.73 m², serum creatinine ≥1.26 mg/dL, and left ventricular ejection fraction <32%. Chronic kidney disease was six-fold more prevalent in rehospitalized patients (25.5% vs. 4.4%; p < 0.001). Conclusions. Pre-discharge B-line quantification is a robust bedside predictor of 90-day rehospitalization in patients with HFrEF. A threshold of ≥20 B-lines identifies patients at high risk who may benefit from intensified decongestion strategies and closer post-discharge monitoring. Integration of lung ultrasound with renal and echocardiographic parameters improves risk stratification and supports the incorporation of lung ultrasound into routine discharge assessment to reduce readmissions.

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