Woo Wongi, Kipkorir Vincent, Marza Adina Maria, Hamouri Shadi, Albawaih Omar, Dhali Arkadeep, Kim Wooshik, Udwadia Zarir F, Nashwan Abdulqadir J, Shaikh Nissar, Belletti Alessandro, Landoni Giovanni, Palumbo Diego, Swed Sarya, Sawaf Bisher, Buonsenso Danilo, Pimenta Inês, Gonzalez Filipe André, Fiorentino Giuseppe, Rashid Ali Muhammad Redzwan S, Quincho-Lopez Alvaro, Javanbakht Mohammad, Alhakeem Ayat, Khan Muhammad Mohsin, Shah Sangam, Rafiee Moezedin Javad, Padala Sri Rama Ananta Nagabhushanam, Diebel Sebastian, Song Seung Hwan, Kang Du-Young, Moon Duk Hwan, Lee Hye Sun, Yang Juyeon, Flower Luke, Yon Dong Keon, Lee Seung Won, Shin Jae Il, Lee Sungsoo
Department of Thoracic and Cardiovascular Surgery, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul 03722, Republic of Korea.
Department of Human Anatomy, School of Medicine, University of Nairobi, Nairobi 00100, Kenya.
J Clin Med. 2022 Nov 30;11(23):7132. doi: 10.3390/jcm11237132.
Pneumothorax and pneumomediastinum are associated with high mortality in invasively ventilated coronavirus disease 2019 (COVID-19) patients; however, the mortality rates among non-intubated patients remain unknown. We aimed to analyze the clinical features of COVID-19-associated pneumothorax/pneumomediastinum in non-intubated patients and identify risk factors for mortality. We searched PubMed Scopus and Embase from January 2020 to December 2021. We performed a pooled analysis of 151 patients with no invasive mechanical ventilation history from 17 case series and 87 case reports. Subsequently, we developed a novel scoring system to predict in-hospital mortality; the system was further validated in multinational cohorts from ten countries ( = 133). Clinical scenarios included pneumothorax/pneumomediastinum at presentation ( = 68), pneumothorax/pneumomediastinum onset during hospitalization ( = 65), and pneumothorax/pneumomediastinum development after recent COVID-19 treatment ( = 18). Significant differences were not observed in clinical outcomes between patients with pneumomediastinum and pneumothorax (±pneumomediastinum). The overall mortality rate of pneumothorax/pneumomediastinum was 23.2%. Risk factor analysis revealed that comorbidities bilateral pneumothorax and fever at pneumothorax/pneumomediastinum presentation were predictors for mortality. In the new scoring system, i.e., the CoBiF system, the area under the curve which was used to assess the predictability of mortality was 0.887. External validation results were also promising (area under the curve: 0.709). The presence of comorbidity bilateral pneumothorax and fever on presentation are significantly associated with poor prognosis in COVID-19 patients with spontaneous pneumothorax/pneumomediastinum. The CoBiF score can predict mortality in clinical settings as well as simplify the identification and appropriate management of patients at high risk.
气胸和纵隔气肿与接受有创通气的2019冠状病毒病（COVID-19）患者的高死亡率相关；然而，非插管患者的死亡率仍然未知。我们旨在分析非插管患者中COVID-19相关气胸/纵隔气肿的临床特征，并确定死亡的危险因素。我们检索了2020年1月至2021年12月的PubMed、Scopus和Embase。我们对来自17个病例系列和87篇病例报告的151例无有创机械通气史的患者进行了汇总分析。随后，我们开发了一种新的评分系统来预测住院死亡率；该系统在来自十个国家的多民族队列中进一步得到验证（n = 133）。临床情况包括就诊时气胸/纵隔气肿（n = 68）、住院期间气胸/纵隔气肿发作（n = 65）以及近期COVID-19治疗后气胸/纵隔气肿发生（n = 18）。纵隔气肿患者与气胸（±纵隔气肿）患者的临床结局未观察到显著差异。气胸/纵隔气肿的总体死亡率为23.2%。危险因素分析显示，合并症、双侧气胸以及气胸/纵隔气肿就诊时发热是死亡的预测因素。在新的评分系统即CoBiF系统中，用于评估死亡率预测能力的曲线下面积为0.887。外部验证结果也很有前景（曲线下面积：0.709）。合并症、双侧气胸以及就诊时发热与COVID-19自发性气胸/纵隔气肿患者的不良预后显著相关。CoBiF评分可以在临床环境中预测死亡率，并简化对高危患者的识别和适当管理。
