Prognosis of Spontaneous Pneumothorax/Pneumomediastinum in Coronavirus Disease 2019: The CoBiF Score.
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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, International Covid-Pneumothorax Working Group Icp-Wg
Аннотация
Objectives: 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. Methods: 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 (n = 133). Results: Clinical scenarios included pneumothorax/pneumomediastinum at presentation (n = 68), pneumothorax/pneumomediastinum onset during hospitalization (n = 65), and pneumothorax/pneumomediastinum development after recent COVID-19 treatment (n = 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). Conclusions: 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.