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Risk factors of pneumothorax and pneumomediastinum in COVID-19: a matched case-control study

 Se Ju Lee  ;  Jinnam Kim  ;  Ki Hyun Lee  ;  Jung Ah Lee  ;  Chang Hyup Kim  ;  Su Hwan Lee  ;  Byung Jo Park  ;  Jung Ho Kim  ;  Jin Young Ahn  ;  Su Jin Jeong  ;  Nam Su Ku  ;  Joon-Sup Yeom  ;  Jun Yong Choi 
 BMC INFECTIOUS DISEASES, Vol.23(1) : 137, 2023-03 
Journal Title
Issue Date
Adult ; COVID-19* / complications ; Case-Control Studies ; Humans ; Mediastinal Emphysema* / epidemiology ; Mediastinal Emphysema* / etiology ; Pneumothorax* / epidemiology ; Pneumothorax* / etiology ; Retrospective Studies
COVID-19 ; Pneumomediastinum ; Pneumothorax ; Risk factors
Background: During the novel coronavirus disease-2019 pandemic, a considerable number of pneumothorax (PNX)/pneumomediastinum (PNM) associated with COVID-19 have been reported, and the incidence is higher in critically ill patients. Despite using a protective ventilation strategy, PNX/PNM still occurs in patients on invasive mechanical ventilation (IMV). This matched case-control study aims to identify the risk factors and clinical characteristics of PNX/PNM in COVID-19.

Methods: This retrospective study enrolled adult patients with COVID-19, admitted to a critical care unit from March 1, 2020, to January 31, 2022. COVID-19 patients with PNX/PNM were compared, in a 1-2 ratio, to COVID-19 patients without PNX/PNM, matched for age, gender, and worst National Institute of Allergy and Infectious Diseases ordinal scale. Conditional logistic regression analysis was performed to assess the risk factors for PNX/PNM in COVID-19.

Results: 427 patients with COVID-19 were admitted during the period, and 24 patients were diagnosed with PNX/PNM. Body mass index (BMI) was significantly lower in the case group (22.8 kg/m2 and 24.7 kg/m2; P = 0.048). BMI was statistically significant risk factor for PNX/PNM in univariate conditional logistic regression analysis [odds ratio (OR), 0.85; confidence interval (CI), 0.72-0.996; P = 0.044]. For patients on IMV support, univariate conditional logistic regression analysis showed the statistical significance of the duration from symptom onset to intubation (OR, 1.14; CI, 1.006-1.293; P = 0.041).

Conclusions: Higher BMI tended to show a protective effect against PNX/PNM due to COVID-19 and delayed application of IMV might be a contributive factor for this complication.
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1. College of Medicine (의과대학) > Dept. of Internal Medicine (내과학교실) > 1. Journal Papers
1. College of Medicine (의과대학) > Dept. of Thoracic and Cardiovascular Surgery (흉부외과학교실) > 1. Journal Papers
Yonsei Authors
Ku, Nam Su(구남수) ORCID logo https://orcid.org/0000-0002-9717-4327
Kim, Jung Ho(김정호) ORCID logo https://orcid.org/0000-0002-5033-3482
Kim, Jin Nam(김진남)
Park, Byung Jo(박병조)
Ahn, Jin Young(안진영) ORCID logo https://orcid.org/0000-0002-3740-2826
Yeom, Joon Sup(염준섭) ORCID logo https://orcid.org/0000-0001-8940-7170
Lee, Ki Hyun(이기현)
Lee, Se Ju(이세주)
Lee, Su Hwan(이수환) ORCID logo https://orcid.org/0000-0002-3487-2574
Lee, Jung Ah(이정아)
Jeong, Su Jin(정수진) ORCID logo https://orcid.org/0000-0003-4025-4542
Choi, Jun Yong(최준용) ORCID logo https://orcid.org/0000-0002-2775-3315
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