Frequency, Risk Factors, Clinical Characteristics, and Outcomes of Spontaneous Pneumothorax in Patients With Coronavirus Disease 2019: A Case-Control, Emergency Medicine-Based Multicenter Study.
COVID-19
/ complications
Case-Control Studies
Emergency Medical Services
/ methods
Female
Hospital Mortality
Humans
Incidence
Male
Middle Aged
Outcome Assessment, Health Care
Pneumothorax
/ diagnostic imaging
Respiration, Artificial
/ methods
Risk Adjustment
Risk Factors
SARS-CoV-2
Spain
/ epidemiology
Symptom Assessment
/ methods
COVID-19
SARS-CoV-2
clinical characteristics
incidence
outcome
risk factors
spontaneous pneumothorax
Journal
Chest
ISSN: 1931-3543
Titre abrégé: Chest
Pays: United States
ID NLM: 0231335
Informations de publication
Date de publication:
03 2021
03 2021
Historique:
received:
02
07
2020
revised:
04
11
2020
accepted:
11
11
2020
pubmed:
24
11
2020
medline:
17
3
2021
entrez:
23
11
2020
Statut:
ppublish
Résumé
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. 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? 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. We identified 40 occurrences of SP in 71,904 patients with COVID-19 attending EDs (0.56‰; 95% CI, 0.40‰-0.76‰). This relative frequency was higher than that among non-COVID-19 patients (387 of 1,358,134, 0.28‰; 95% CI, 0.26‰-0.32‰; 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. SP as a form of COVID-19 presentation at the ED is unusual (< 1‰ 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.
Sections du résumé
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 METHODS
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‰; 95% CI, 0.40‰-0.76‰). This relative frequency was higher than that among non-COVID-19 patients (387 of 1,358,134, 0.28‰; 95% CI, 0.26‰-0.32‰; 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‰ 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.
Identifiants
pubmed: 33227276
pii: S0012-3692(20)35201-6
doi: 10.1016/j.chest.2020.11.013
pmc: PMC7678420
pii:
doi:
Types de publication
Journal Article
Multicenter Study
Langues
eng
Sous-ensembles de citation
IM
Pagination
1241-1255Investigateurs
Òscar Miró
(Ò)
Sònia Jiménez
(S)
Juan González Del Castillo
(J)
Francisco Javier Martín-Sánchez
(FJ)
Pere Llorens
(P)
Guillermo Burillo-Putze
(G)
Alfonso Martín
(A)
Pascual Piñera Salmerón
(PP)
E Jorge García Lamberechts
(EJ)
Javier Jacob
(J)
Aitor Alquézar-Arbé
(A)
María Luisa López Grima
(ML)
María Ángeles Juan Gómez
(MÁ)
Javier Millán
(J)
Leticia Serrano Lázaro
(LS)
Bárbara Peña
(B)
Francisco Román
(F)
José Noceda
(J)
María José Cano Cano
(MJ)
Rosa Sorando Serra
(RS)
María José Fortuny Bayarri
(M)
Francisco José Salvador Suárez
(F)
Matilde González Tejera
(MG)
Liced Aguilar Herrera
(LA)
Ana María Caballero Mateos
(AM)
Napoleón Meléndez
(N)
Patricia Borrás Albero
(PB)
Blas Jiménez
(B)
Rigoberto Del Río
(RD)
Blas Jiménez
(B)
Carles Pérez García
(CP)
Pilar Sánchez Amador
(PS)
José Vicente Brasó Aznar
(JV)
José Luis Ruiz López
(JL)
María Carmen Ponce
(MC)
Elena Díaz Fernández
(ED)
Elena Díaz Fernández
(ED)
Laura Ejarque Martínez
(LE)
Marisa de Reynoso Rodríguez
(M)
Ana Peiró Gómez
(AP)
Elena Gonzalo Bellver
(EG)
Miguel Rizzi
(M)
Carla Cabrera Suarez
(CC)
Laura Balcells Argilag
(LB)
Carlos Cardozo
(C)
Alejandro Roset-Rigat
(A)
Antonio Haro-Bosch
(A)
Marta Alujas Rovira
(MA)
Pepe Ferrer Arbaizar
(PF)
Josep Tost
(J)
Isabel Cirera Lorenzo
(IC)
Silvia Mínguez Masó
(SM)
Anna Palau
(A)
Ruth Gaya Tur
(RG)
Maria Adroher Muñoz
(MA)
Ester Soy Ferrer
(ES)
Lluís Llauger García
(LL)
Brigitte Silvana Alarcón Jiménez
(BS)
Silvia Flores Quesada
(SF)
Arturo Huerta
(A)
Marcos Fragiel
(M)
Susana Martínez Álvarez
(SM)
Ana María Martínez Virto
(AM)
Carmen Del Arco Galán
(CDA)
Guillermo Fernández Jiménez
(GF)
Esther Álvarez Rodríguez
(EÁ)
Teresa Agudo Villa
(TA)
María José Venegas de L'Hotellerie
(MJ)
Verónica Prieto Cabezas
(VP)
Catalina Mocanu
(C)
Patricia Gantes Nieto
(PG)
Marta Álvarez Alonso
(MÁ)
Cristina Latorre Marco
(CL)
Alicia Fuente Gaforio
(AF)
Beatriz Honrado Galán
(BH)
Sara Gayoso Martín
(SG)
Frida Vallejo Somohano
(FV)
Nieves López Laguna
(NL)
Raquel Piñero Panadero
(RP)
Marta Fuentes de Frutos
(M)
Cristina Gil Castillo
(CG)
Ana Barrientos Castañeda
(AB)
Susana Garcia Escudero
(SG)
María Pilar López Díez
(MP)
Jose Ramón Oliva Ramos
(JR)
Daniel Serrano Herrero
(DS)
Rosa Castellanos Flórez
(RC)
Fadh Beddar Chaib
(FB)
Ikram Samira Mohamedi Abdelkader
(IS)
Ana Pérez Tornero
(AP)
Alberto Núñez Chia
(AN)
Esther Maldonado Pérez
(EM)
Verónica Rodríguez Martín
(VR)
Ana Belen García Soto
(AB)
Elisa Delgado Padial
(ED)
Jorge Pedraza García
(JP)
Amparo Fernández de Simón Almela
(A)
Ricardo Calvo López
(RC)
Juan José López Díaz
(J)
María Teresa Maza Vera
(MT)
Raquel Rodríguez Calveiro
(RR)
Francisco Javier Lucas-Galán
(FJ)
María Ruipérez Moreno
(MR)
Félix González Martínez
(FG)
Diana Moya Olmeda
(DM)
Ricardo Juárez
(R)
Marcos Expósito Rodríguez
(ME)
José Francisco Fernández Rodríguez
(JF)
José Pavón Monzo
(JP)
Nayra Cabrera González
(NC)
Desiré María Velarde Herrera
(DM)
Beatriz María Martínez Bautista
(BM)
Ana Patricia Niembro Valdés
(AP)
Lorena Arboleya Álvarez
(LA)
Eva Quero Motto
(EQ)
Nuria Tomas García
(NT)
José Andrés Sánchez Nicolás
(JA)
Paula Lázaro Aragües
(PL)
Noemí Ruiz de Lobera
(N)
José María Ferreras Amez
(JM)
Commentaires et corrections
Type : CommentIn
Type : CommentIn
Informations de copyright
Copyright © 2020 American College of Chest Physicians. Published by Elsevier Inc. All rights reserved.
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