Frequency, Risk Factors, Clinical Characteristics, and Outcomes of Spontaneous Pneumothorax in Patients With Coronavirus Disease 2019 A Case-Control, Emergency Medicine-Based Multicenter Study
Por:
Miro, O, Llorens, P, Jimenez, S, Pinera, P, Burillo-Putze, G, Martin, A, Martin-Sanchez, FJ, Garcia-Lamberetchs, EJ, Jacob, J, Alquezar-Arbe, A, Modol, JM, Lopez-Diez, MP, Guardiola, JM, Cardozo, C, Imbernon, FJL, Tejedo, AA, Garcia, AG, Grinspan, MR, Roca, FL, del Castillo, JG
Publicada:
1 mar 2021
Ahead of Print:
1 mar 2021
Resumen:
BACKGROUND Recent reports of patients with coronavirus disease 2019 (COVID-19) developing pneumothorax correspond mainly to case reports describing mechanically ventilated patients. The real incidence, clinical characteristics, and outcome of spontaneous pneumothorax (SP) as a form of COVID-19 presentation remain to be defined.
RESEARCH QUESTION: Do the incidence, risk factors, clinical characteristics, and outcomes of SP in patients with COVID-19 attending EDs differ compared with COVID-19 patients without SP and non-COVID-19 patients with SP?
STUDY DESIGN AND METHOD: This case-control study retrospectively reviewed all patients with COVID-19 diagnosed with SP (case group) in 61 Spanish EDs (20% of Spanish EDs) and compared them with two control groups: COVID-19 patients without SP and non-COVID-19 patients with SP. The relative frequencies of SP were estimated in COVID-19 and non-COVID-19 patients in the ED, and annual standardized incidences were estimated for both populations. Comparisons between case subjects and control subjects included 52 clinical, analytical, and radiologic characteristics and four outcomes.
RESULTS: We identified 40 occurrences of SP in 71,904 patients with COVID-19 attending EDs (0.56 parts per thousand; 95% CI, 0.40% 0 -0.76 parts per thousand). This relative frequency was higher than that among non-COVID-19 patients (387 of 1,358,134, 0.28 parts per thousand; 95% CI, 0.26 parts per thousand 0 -0.32 parts per thousand; OR, 1.93; 95% CI, 1.41-2.71). The standardized incidence of SP was also higher in patients with COVID-19 (34.2 vs 8.2/100,000/year; OR, 4.19; 95% CI, 3.64-4.81). Compared with COVID-19 patients without SP, COVID-19 patients developing SP more frequently had dyspnea and chest pain, low pulse oximetry readings, tachypnea, and increased leukocyte count. Compared with non-COVID-19 patients with SP, case subjects differed in 19 clinical variables, the most prominent being a higher frequency of dysgeusia/ anosmia, headache, diarrhea, fever, and lymphopenia (all with OR > 10). All the outcomes measured, including in-hospital death, were worse in case subjects than in both control groups.
INTERPRETATION: SP as a form of COVID-19 presentation at the ED is unusual (< 1 parts per thousand cases) but is more frequent than in the non-COVID-19 population and could be associated with worse outcomes than SP in non-COVID-19 patients and COVID-19 patients without SP.
Filiaciones:
Miro, O:
Univ Barcelona, Hosp Clin, IDIBAPS, Emergency Dept, Barcelona, Spain
Llorens, P:
Univ Miguel Hernandez, Hosp Gen Alicante, Emergency Dept, Elche, Spain
Jimenez, S:
Univ Barcelona, Hosp Clin, IDIBAPS, Emergency Dept, Barcelona, Spain
Pinera, P:
Hosp Reina Sofia, Emergency Dept, Murcia, Spain
Burillo-Putze, G:
Hosp Univ Canarias, Emergency Dept, Tenerife, Spain
Martin, A:
Hosp Severo Ochoa, Emergency Dept, Madrid, Spain
Martin-Sanchez, FJ:
Univ Complutense, IDISSC, Hosp Clin San Carlos, Emergency Dept, Madrid, Spain
Garcia-Lamberetchs, EJ:
Univ Complutense, IDISSC, Hosp Clin San Carlos, Emergency Dept, Madrid, Spain
Jacob, J:
Hosp Univ Bellvitge, Emergency Dept, Barcelona, Spain
Alquezar-Arbe, A:
Hosp Santa Creu & Sant Pau, Emergency Dept, Barcelona, Spain
Modol, JM:
Hosp Badalona Germans Trias & Pujol, Emergency Dept, Barcelona, Spain
Lopez-Diez, MP:
Hosp Univ Burgos, Emergency Dept, Madrid, Spain
Guardiola, JM:
Hosp Santa Creu & Sant Pau, Emergency Dept, Barcelona, Spain
Cardozo, C:
Univ Barcelona, Hosp Clin, IDIBAPS, Emergency Dept, Barcelona, Spain
Hosp Austral, Emergency Dept, Buenos Aires, DF, Argentina
Imbernon, FJL:
Hosp Gen Albacete, Emergency Dept, Albacete, Spain
Tejedo, AA:
Hosp del Mar, Emergency Dept, Barcelona, Spain
Garcia, AG:
Hosp Clin Univ Salamanca, Salamanca, Spain
Grinspan, MR:
Hosp Henares, Emergency Dept, Madrid, Spain
Roca, FL:
Hosp Univ Bellvitge, Emergency Dept, Barcelona, Spain
del Castillo, JG:
Univ Complutense, IDISSC, Hosp Clin San Carlos, Emergency Dept, Madrid, Spain
Bronze, Green Published
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