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Frequency, Risk Factors, Clinical Characteristics, and Outcomes of Spontaneous Pneumothorax in Patients With Coronavirus Disease 2019

2020; Elsevier BV; Volume: 159; Issue: 3 Linguagem: Inglês

10.1016/j.chest.2020.11.013

1931-3543

Òscar Miró, Pere Llorens, Sònia Jiménez, Pascual Piñera, Guillermo Burillo–Putze, Alfonso Martı́n, Francisco Javier Martín‐Sánchez, Eric Jorge García-Lamberetchs, Javier Jacob, Aitor Alquézar‐Arbé, Josep María Mòdol, María Pilar López‐Díez, Josep M. Guardiola, Carlos Cardozo, Francisco Javier Lucas Imbernón, Alfons Aguirre Tejedo, Àngel García García, M. Ruiz Grinspan, Ferrán Llopis Roca, Juan González del Castillo, Òscar Miró, Sònia Jiménez, Juan González del Castillo, Francisco Javier Martín‐Sánchez, Pere Llorens, Guillermo Burillo–Putze, Alfonso Martı́n, Pascual Piñera, Eric Jorge García Lamberechts, Javier Jacob, Aitor Alquézar‐Arbé, María Luisa López Grima, María Ángeles Gómez, Javier Millán, Leticia Serrano Lázaro, Bárbara Pérez Pena, Francisco Román, José Noceda, María José Cano Cano, Rosa Sorando Serra, M. J. Bayarri, Francisco José Salvador Suárez, Matilde González Tejera, Liced Aguilar Herrera, Ana María Caballero Mateos, Napoleón Meléndez, Patricia Borrás Albero, Blas Jiménez, Rigoberto del Río, Blas Jiménez, Carles Pérez García, Pilar Sánchez Amador, José Vicente Brasó Aznar, José Luis Ruiz López, María Carmen Ponce, Elena Díaz Fernández, Elena Díaz Fernández, Laura Martínez, Marisa de Reynoso Rodríguez, Ana Peiró Gómez, Elena Gonzalo Bellver, Miguel Alberto Rizzi, Carla Cabrera Suarez, Laura Balcells Argilag, Carlos Cardozo, Alejandro Roset-Rigat, Antonio Haro-Bosch, Marta Alujas Rovira, Pepe Ferrer Arbaizar, Josep Tost, Isabel Cirera Lorenzo, Silvia Mínguez Masó, Anna Palau, Ruth Gaya Tur, María Adroher Múñoz, Ester Soy Ferrer, Lluís Llauger García, Brigitte Silvana Alarcón Jiménez, Silvia Ambite‐Quesada, Arturo Huerta, Marcos Fragiel, Susana Martínez Álvarez, Ana María Martínez Virto, Carmen del Arco, Guillermo Fernández Jiménez, Esther Álvarez-Rodríguez, Teresa Agudo Villa, María José Venegas de L’Hotellerie, Verónica Prieto Cabezas, C Mocanu, Patricia Gantes Nieto, Marta Álvarez Alonso, Cristina Latorre Marco, Alicia Fuente Gaforio, Beatriz Honrado Galán, Sara Gayoso Martín, Frida Vallejo Somohano, Nieves López-Laguna, Raquel Piñero Panadero, Marta Fuentes de Frutos, Cristina Gil Castillo, Ana Barrientos Castañeda, S. Escudero, María Pilar López Díez, José Ramón Oliva Ramos, Daniel Herrero, Rosa Castellanos Flórez, Fadh Beddar Chaib, Ikram Samira Mohamedi Abdelkader, Ana Pérez Tornero, Alberto Núñez Chia, Esther Maldonado Pérez, Verónica Rodríguez Martín, Ana Belen García Soto, Elisa Delgado Padial, Jorge Pedraza García, Amparo Fernández de Simón Almela, Ricardo Calvo López, Juan José López Díaz, María Teresa Maza Vera, Raquel Rodríguez Calveiro, Francisco Javier Lucas-Galán, María Moreno, Félix González Martínez, Diana Moya Olmeda, Ricardo Juárez, Marcos Expósito Rodríguez, José Francisco Fernández Rodríguez, José Pavón Monzó, Nayra Cabrera González, Sergio Herrera, Beatriz María Martínez Bautista, Ana Patricia Niembro Valdés, Lorena Arboleya Álvarez, Eva Quero Motto, Nuria Tomas García, José Andrés Sánchez Nicolás, Paula Lázaro Aragüés, Noemí Ruiz de Lobera, José María Ferreras Amez,

Respiratory Support and Mechanisms

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.