Farronato Arianna, Travaglia Chiara, Ravasin Alice, Aprile Vittorio, Corzani Roberto, Sicolo Elisa, Peris Adriano, Romagnoli Stefano, Lucchi Marco, Paladini Piero, Voltolini Luca, Gonfiotti Alessandro
Thoracic Surgery Unit, Department of Experimental and Clinical Medicine, University Hospital of Florence Careggi, Florence, Italy.
Department of Health Science, Section of Anaesthesia and Intensive Care, University Hospital of Florence Careggi, Florence, Italy.
Interdiscip Cardiovasc Thorac Surg. 2025 May 6;40(5). doi: 10.1093/icvts/ivaf076.
Pneumothorax and pneumomediastinum have been frequently reported in coronavirus disease-19 (COVID-19), thus complicating the patient's overall health-care management and survival rate. The goal of this study was to evaluate the outcomes of patients with COVID-19 who developed spontaneous pneumothorax (SPN) or spontaneous pneumomediastinum (SPM).
In this Italian multicentre retrospective cohort study, medical records of non-vaccinated COVID-19 patients, from March 2020 to May 2021, were analysed. To reduce the risk of bias due to unbalanced groups, a propensity score matching approach was applied using logistic regression to estimate propensity scores. Separate multivariable generalized linear models were then used to assess the risk of in-hospital death and other outcomes.
A total of 474 patients were assessed, 72 of whom developed SPN or SPM. In separate multivariable generalized linear model regression analyses of the unmatched cohort, SPN [odds ratio (OR) 2.44, 95% confidence interval (CI) 1.7-5.55; P = 0.031] was associated with an increase in the in-hospital death rate, results confirmed even after matching the 2 cohorts. SPM (OR 1.21, 95% CI 1.13-1.30, P < 0.001) and SPN (OR 1.34, 95% CI 1.26-1.43, P < 0.001) were associated with an increase in the length of hospital stay. The risk of in-hospital death also increased with age, comorbidities (classified by the Charlson comorbidity index) and smoking habits.
SPN in hospitalized COVID-19 patients may be associated with an increased risk of in-hospital death and prolonged hospitalization.
气胸和纵隔气肿在冠状病毒病19（COVID-19）中屡有报道，从而使患者的整体医疗管理和生存率变得复杂。本研究的目的是评估发生自发性气胸（SPN）或自发性纵隔气肿（SPM）的COVID-19患者的预后。
在这项意大利多中心回顾性队列研究中，分析了2020年3月至2021年5月未接种疫苗的COVID-19患者的病历。为降低因组间不平衡导致的偏倚风险，采用倾向评分匹配方法，使用逻辑回归估计倾向评分。然后使用单独的多变量广义线性模型评估住院死亡风险和其他结局。
共评估了474例患者，其中72例发生了SPN或SPM。在未匹配队列的单独多变量广义线性模型回归分析中，SPN[比值比（OR）2.44，95%置信区间（CI）1.7 - 5.55；P = 0.031]与住院死亡率增加相关，在两个队列匹配后结果仍得到证实。SPM（OR 1.21，95% CI 1.13 - 1.30，P < 0.001）和SPN（OR 1.34，95% CI 1.26 - 1.43，P < 0.001）与住院时间延长相关。住院死亡风险也随着年龄、合并症（根据Charlson合并症指数分类）和吸烟习惯的增加而增加。
住院COVID-19患者发生SPN可能与住院死亡风险增加和住院时间延长有关。
