Assessment of Potential Risk Factors, Characteristics, and Outcome of Pneumothorax and Pneumomediastinum in Patients with COVID-19: A Retrospective Case-control Study
Published: November 1, 2022 | DOI: https://doi.org/10.7860/JCDR/2022/57842.17012
T Prasanna Kumar, K Madan, AS Arjun, N Monica
1. Associate Professor, Department of Respiratory Medicine, MS Ramaiah Medical College, Bangalore, Karnataka, India.
2. Assistant Professor, Department of General Surgery, MS Ramaiah Medical College, Bangalore, Karnataka, India.
3. Senior Resident, Department of Respiratory Medicine, Bangalore Medical College and Research Institute, Bangalore, Karnataka, India.
4. Junior Resident, Department of General Surgery, MS Ramaiah Medical College, Bangalore, Karnataka, India.
Correspondence
Dr. T Prasanna Kumar,
Associate Professor, Department of Respiratory Medicine, MS Ramaiah Medical College, MSRIT Post, MSR Nagar, Bangalore-560054, Karnataka, India.
E-mail: prasannakumart@msrmc.ac.in
Introduction: Pneumothorax (PTX) and/or Pneumomediastinum (PMD) are rare complications of Coronavirus Disease-2019 (COVID-19) and are linked to high mortality. Incidence rates vary between 0.56-2.01% in the reported literature. With clinical examination being hampered in the current pandemic setting, there is a delay in the diagnosis. There is a need to identify and establish potential predictive factors, that may aid in identifying patients with a high-risk of developing PTX and/or PMD.
Aim: To identify potential risk factors and thus, explore their association with PTX and/or PMD among patients with COVID-19.
Materials and Methods: A retrospective case-control study was conducted at MS Ramaiah Medical College and Hospital, Bangalore, Karnataka, India, over a six-month period. A total of 130 patients diagnosed with COVID-19 were recruited in a 1:3 ratio as cases and controls, respectively. The study included 31 consecutive patients with PTX and/or PMD (cases) and 99 consecutive patients serving as controls, Cases were patients, diagnosed radiologically with PTX and/or PMD, and controls were, matched individuals without PTX and/or PMD. Patient’s clinical and laboratory parameters (complete blood count, renal and liver function tests, serum levels of inflammatory markers such as C-reactive protein (CRP), lactate dehydrogenase (LDH), and D-Dimer were tested for potential association with PTX and/or PMD. Student’s t-test, Chi-square test, multivariate and univariate logistic regression analysis were performed.
Results: During the study period, there was a total of 3,251 COVID-19 admissions at the centre, with 976 patients requiring Intensive Care Unit (ICU) admission. The overall incidence of PTX and/or PMD during the study period was (31/3251) 0.95%. The previous history of COVID-19, non vaccination with COVID19 vaccine, cough as a predominant symptom, high values of baseline CRP, total bilirubin, Aspartate Transaminase (AST), and total leukocyte counts had a positive association. In-hospital mortality (54.8% vs 33.30%) and 28-day mortality (35.7% vs 7.6%) following discharge, were higher among those with PTX and/or PMD.
Conclusion: Patients with a history of previous infection with COVID-19, non vaccination/incomplete-vaccination with COVID-19 vaccines, and patients with increasing total leukocyte counts and AST levels, high baseline total serum bilirubin were at increased risk of a detrimental clinical course and may indicate, the possibility of development of PTX and/or PMD in COVID-19 disease.
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